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HOLLY EDSON NP
NPI 1053914176
Nurse Practitioner - Family in San Rafael, CA

Active since November 19, 2020PECOS Enrolled
4340 REDWOOD HWY STE A-22, SAN RAFAEL, CA 94903(415) 509-5493 Get Directions Write a Review

NPPES record last updated: November 19, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Holly Edson Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HOLLY EDSON NP (NPI 1053914176) is an individual family provider in San Rafael, California, licensed in California (95015996) and active in the NPI registry since November 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053914176
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameHOLLY EDSONCredential: NP
Location Address4340 REDWOOD HWY STE A-22San Rafael, CA 94903-2121
Mailing Address4340 Redwood Hwy Ste A-22San Rafael, CA 94903-2121 · (415) 472-2343
Phone(415) 509-5493
Sole ProprietorNo
Enumeration DateNovember 19, 2020
NPPES CertifiedOctober 29, 2020
✔ NPI 1053914176 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in CA · 95015996
4340 REDWOOD HWY STE A-22, San Rafael, CA 94903
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Holly Edson Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Holly Edson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Preventive Medical Center Of Marin Inc
Same address
Primary Care
4340 REDWOOD HWY STE AA
San Rafael, CA 94903
  • Reassigned Medicare billing, California enrollment
  • 4 clinicians in this Medicare group
NPI 1912067828 (415) 472-2343

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94903 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$104.67 typical visit price
range $69.07 – $202.63
Typical copayment $26.16 (range $17.26 – $50.65)
Most-billed visit code 99203
Established Patient
$119.61 typical visit price
range $23.44 – $166.64
Typical copayment $29.90 (range $5.86 – $41.66)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANUCHEAT CHEA M.D.
General Practice
4340 REDWOOD HWY STE A-22
SAN RAFAEL, CA 94903
Marin County (415) 472-2343

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Holly Edson's NPI number?

The NPI number for Holly Edson is 1053914176. It was assigned to this individual provider in the NPPES registry on November 19, 2020.

Where is Holly Edson located?

Holly Edson practices at 4340 Redwood Hwy Ste A-22, San Rafael, CA 94903. The listed phone number is (415) 509-5493.

What is Holly Edson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Holly Edson enrolled in Medicare?

Yes. Holly Edson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Holly Edson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Holly Edson reassigns Medicare benefits to Preventive Medical Center Of Marin Inc (San Rafael, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Holly Edson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Holly Edson was last updated on November 19, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.