Individual provider Active NPI

Russell Philip Edwards, M.D.

  • Ophthalmology Physician
  • San Diego, CA
National Provider Identifier
1922003706
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G57008 Issued in CA
Practice address
3969 4TH Ave
Ste 301
San Diego, CA 92103-3165
Phone
(619) 291-6191
Fax
(619) 291-0049
NPI assigned
Jun 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X G57008 CA Primary

Addresses

Primary practice location

3969 4TH Ave
Ste 301
San Diego, CA 92103-3165

Mailing address

3969 4TH Ave
Ste 301
San Diego, CA 92103-3165
Phone (858) 566-0686

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050217000356 CA Practitioner - Ophthalmology 4789636994 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health CurrentSince Jan 21, 2005 Accepting new patients
Scripps Health Current Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Sep 5, 2010 Accepting new patients
Scripps Health Ophthalmology Current Accepting new patients
Scripps Health CurrentSince Jan 21, 2005 Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

3811 Valley Centre Dr
San Diego, CA 92130
Phone (858) 554-8645

4060 4th Ave
Ste 330
San Diego, CA 92103
Phone (619) 291-2274

9730 Summers Ridge Rd
#100
San Diego, CA 92121
Phone (858) 549-7400

Interoperability endpoints

  • Direct secure messaging: redwards37450@scrippshlth.medalliesdirect.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1922003706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3969 4TH AVE",
            "address_2": "STE 301",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033165",
            "telephone_number": "858-566-0686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3969 4TH AVE",
            "address_2": "STE 301",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033165",
            "telephone_number": "619-291-6191",
            "fax_number": "619-291-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "RUSSELL",
        "middle_name": "PHILIP",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G57008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.