Evan Edelist

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

114 San Rafael Ave
San Rafael, CA 94901-3645

Phone

(415) 300-5463

NPI assigned

May 28, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1653696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653696000000",
    "number": "1801535851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150429",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949150429",
            "telephone_number": "415-300-5463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 SAN RAFAEL AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013645",
            "telephone_number": "415-300-5463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELIST",
        "first_name": "EVAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-28",
        "last_updated": "2022-05-28",
        "certification_date": "2022-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://maringerontology.com/",
            "affiliation": "N",
            "endpointDescription": "Gerontology business website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "https://maringerontology.com/",
            "address_1": "114 San Rafael Ave",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949013645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Damian Alfonso Edwards, CASE 1

• Case Manager/Care Coordinator in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.