NPIMap

Individual provider Active NPI

Travis Edmiston, MD

  • Spinal Cord Injury Medicine Physician
  • Downey, CA
National Provider Identifier
1689093023
Registry record updated Sep 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Spinal Cord Injury Medicine PhysicianTaxonomy code 2081P0004X
License
165566 Issued in CA
Practice address
7601 Imperial Hwy
Downey, CA 90242-3456
Phone
(562) 385-7713
NPI assigned
Apr 14, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Spinal Cord Injury Medicine Physician 2081P0004X 165566 CA Primary

Addresses

Primary practice location

7601 Imperial Hwy
Downey, CA 90242-3456

Mailing address

4025 SW Condor Ave
Portland, OR 97239-4172
Phone (541) 740-8978

Other practice location 1

1959 NE Pacific St
Box 356410
Seattle, WA 98195-0001
Phone (206) 543-3654

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220212000005 MD Practitioner - Physical Medicine and Rehabilitation 8729307814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Oregon Health Sciences University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kennedy Krieger AssociatesGroup PAC ID 1759280597, 73 clinicians

Practice addresses (Care Compare)

707 N Broadway
Baltimore, MD 21205-1832
Phone (443) 923-9200

Hospital & facility affiliations

  • Kennedy Krieger Institute Hospital, Baltimore, MD, CCN 213301
  • Johns Hopkins Hospital, the Hospital, Baltimore, MD, CCN 210009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
165566CAMDSpinal Cord Injury Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kennedy Krieger Associates CurrentSince Jan 20, 2022 Accepting new patients
Kennedy Krieger Associates CurrentSince Jan 20, 2022 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

707 N Broadway
Baltimore, MD 21205
Phone (443) 923-1870

1741 Ashland Ave
Baltimore, MD 21205
Phone (443) 923-1842

11830 W Market Pl
Fulton, MD 20759
Phone (443) 923-9327

Interoperability endpoints

  • Direct secure messaging: tedmiston9427@direct.kennedykrieger.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1689093023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 SW CONDOR AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394172",
            "telephone_number": "541-740-8978"
        },
        {
            "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": "562-385-7713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1959 NE Pacific St",
            "address_2": "Box 356410",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981950001",
            "country_code": "US",
            "telephone_number": "206-543-3654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDMISTON",
        "first_name": "TRAVIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-14",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "CA",
            "license": "165566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downey, CA

Sources for this page

Verify at the official NPI Registry.