Active NPI
Edmond Jackson Clinton III, M.D.
- Internal Medicine Physician
- Pasadena, CA
National Provider Identifier
1720094097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- G029665
- Practice address
- 65 N Madison Ave Ste 707
Pasadena, CA 91101-2046 - Phone
- (626) 792-1135
- Fax
- (626) 792-9793
- NPI assigned
- Jul 31, 2006
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G029665 | CA | Primary |
Addresses
Primary practice location
65 N Madison Ave Ste 707
Pasadena, CA 91101-2046
Mailing address
65 N Madison Ave Ste 707
Pasadena, CA 91101-2046
Phone (626) 792-1135
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G029665 | CA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720094097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 N MADISON AVE STE 707",
"city": "PASADENA",
"state": "CA",
"postal_code": "911012046",
"telephone_number": "626-792-1135",
"fax_number": "626-792-9793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 N MADISON AVE STE 707",
"city": "PASADENA",
"state": "CA",
"postal_code": "911012046",
"telephone_number": "626-792-1135",
"fax_number": "626-792-9793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLINTON",
"first_name": "EDMOND",
"middle_name": "JACKSON",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G029665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.