EDGEMONT MEDICAL CLINIC
NPI 1588078166
Family Medicine in Los Angeles, CA
About Edgemont Medical Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EDGEMONT MEDICAL CLINIC (NPI 1588078166) is a healthcare organization registered as a family medicine in Los Angeles, California and active in the NPI registry since June 2014. The organization holds a CLIA Waiver certificate valid through November 30, 2026 and lists Manuk Chulyan, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Edgemont Medical Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Edgemont Medical Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2087565
Edgemont Medical Clinic · Los Angeles, CAFrequently 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 Edgemont Medical Clinic's NPI number?
The NPI number for Edgemont Medical Clinic is 1588078166. It was assigned to this organization in the NPPES registry on June 11, 2014.
Where is Edgemont Medical Clinic located?
Edgemont Medical Clinic is located at 4864 Santa Monica Blvd, Los Angeles, CA 90029. The listed phone number is (323) 661-2700.
What is Edgemont Medical Clinic's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Edgemont Medical Clinic enrolled in Medicare?
Yes. Edgemont Medical Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Edgemont Medical Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Emergency Medicine) reassigns their Medicare billing to Edgemont Medical Clinic. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Edgemont Medical Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2087565) is associated with this NPI, valid through November 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Edgemont Medical Clinic was last updated on September 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 45 days 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.
# Edgemont Medical Clinic · NPI 1588078166
Family Medicine organization in Los Angeles, California. Organization record, active in the CMS NPPES registry since June 11, 2014.
## Identity
- **NPI:** 1588078166 (Entity type: Organization)
- **Enumerated:** June 11, 2014
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Also known as:** Edgemont Medical Clinic (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Manuk Chulyan, PRESIDENT
## Practice location
- **Address:** 4864 SANTA MONICA BLVD, Los Angeles, CA 90029-2634
- **Phone:** (323) 661-2700 · **Fax:** (323) 661-2702
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Emergency Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 23, 2026
- **Other identifiers:** Other 1043482060 (CA); Other 1881986826 (CA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1588078166) · Data from the CMS NPPES public registry.