Active NPI
Roberto Jose Medina, DC
- Chiropractor
- Las Vegas, NV
National Provider Identifier
1013559533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- B01794
- Practice address
- 8678 Spring Mountain Rd Ste 110
Las Vegas, NV 89117-4103 - Phone
- (702) 644-3333
- Fax
- (702) 644-3336
- NPI assigned
- Oct 16, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | B01794 | NV | Primary |
Addresses
Primary practice location
8678 Spring Mountain Rd Ste 110
Las Vegas, NV 89117-4103
Mailing address
8678 Spring Mountain Rd Ste 110
Las Vegas, NV 89117-4103
Phone (702) 644-3333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B01794 | Other | NV | CHIROPRACTIC PHYSICIANS BOARD OF NEVADA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | lasvegas | Other | NBC Operations, LLC |
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
Networks
- UT PPO
- UT PPO D-SNP
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1013559533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8678 SPRING MOUNTAIN RD STE 110",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891174103",
"telephone_number": "702-644-3333",
"fax_number": "702-644-3336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8678 SPRING MOUNTAIN RD STE 110",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891174103",
"telephone_number": "702-644-3333",
"fax_number": "702-644-3336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "ROBERTO",
"middle_name": "JOSE",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-16",
"last_updated": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NV",
"license": "B01794",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIROPRACTIC PHYSICIANS BOARD OF NEVADA",
"identifier": "B01794",
"state": "NV"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "lasvegas",
"affiliation": "Y",
"affiliationName": "NBC Operations, LLC",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "lasvegas",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "lasvegas",
"address_1": "8678 Spring Mountain Rd Ste 110",
"city": "Las Vegas",
"state": "NV",
"country_code": "US",
"postal_code": "891174103",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.