Active NPI
Raymond Edward Erny, M.D.
- Cardiovascular Disease Physician
- Petaluma, CA
National Provider Identifier
1891793741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- G52583
- Practice address
- 719 Southpoint Blvd
Ste B
Petaluma, CA 94954-1495 - Phone
- (707) 778-8421
- Fax
- (707) 778-1702
- NPI assigned
- Jul 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | G52583 | CA | Primary |
| Interventional Cardiology Physician | 207RI0011X | G52583 | CA |
Addresses
Primary practice location
719 Southpoint Blvd
Ste B
Petaluma, CA 94954-1495
Mailing address
3536 Mendocino Ave
Ste 200
Santa Rosa, CA 95403-3634
Phone (707) 585-6049
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G525830 | Other | CA | BLUE SHIELD OF CALIFORNIA |
| 00G525830 | Medicaid | CA | |
| 060014838 | Other | CA | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| G52583 | CA | MD | Interventional Cardiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328572800000",
"number": "1891793741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3536 MENDOCINO AVE",
"address_2": "STE 200",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033634",
"telephone_number": "707-585-6049",
"fax_number": "707-778-1702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 SOUTHPOINT BLVD",
"address_2": "STE B",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949541495",
"telephone_number": "707-778-8421",
"fax_number": "707-778-1702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERNY",
"first_name": "RAYMOND",
"middle_name": "EDWARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-13",
"last_updated": "2012-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "G52583",
"primary": true
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "CA",
"license": "G52583",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CALIFORNIA",
"identifier": "00G525830",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G525830",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "060014838",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.