Scott A Edelstein, P.A-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

0010-01875 Issued in NC

Practice address

101 Bodin Cir
101 Bodin Cir
Travis Afb, CA 94535-1809

Phone

(707) 423-2300

NPI assigned

May 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450137600000",
    "number": "1831145267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "address_2": "60 MDG/SGCS",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "address_2": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELSTEIN",
        "first_name": "SCOTT",
        "middle_name": "A",
        "credential": "P.A-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2015-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009553",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-01875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02511360",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John P Dutton, M.D.
• Tatiana Dykes, RD
• Cynthia Sabin Eades, M.S., CCC-A
• Zachary Ryan Eagle, MD
• David V Eastham, MD, MPH
• Brody Tanner Ehalt, IDMT
• Donald Andrew Ehasz, D.C.
• Haris Ehland, D.M.D., M.S.
• Jonathan Eilers
• Erica Elledge

• Surgical Physician Assistant in Travis Afb, CA
• Providers in Travis Afb, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.