Active NPI
Chris Edmund Ediss, PA-C
- Physician Assistant
- Downey, CA
National Provider Identifier
1639374671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 15274
- Practice address
- 7601 Imperial Hwy
Downey, CA 90242-3456 - Phone
- (562) 401-7115
- Fax
- (562) 401-6247
- NPI assigned
- Jun 19, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 15274 | CA | Primary |
Addresses
Primary practice location
7601 Imperial Hwy
Downey, CA 90242-3456
Mailing address
17282 Minden Dr
Yorba Linda, CA 92886-3219
Phone (714) 993-6193
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220927003747 | CA | Order and Referring Only - Physician Assistant | 0840349577 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15274 | CA | MD | Chiropractor |
| PA 15274 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639374671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17282 MINDEN DR",
"city": "YORBA LINDA",
"state": "CA",
"postal_code": "928863219",
"telephone_number": "714-993-6193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7601 IMPERIAL HWY",
"city": "DOWNEY",
"state": "CA",
"postal_code": "902423456",
"telephone_number": "562-401-7115",
"fax_number": "562-401-6247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDISS",
"first_name": "CHRIS",
"middle_name": "EDMUND",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA 15274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Downey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.