Individual provider Active NPI

Zachary Ryan Medo, PA-C

  • Physician Assistant
  • West Lafayette, IN
National Provider Identifier
1023838455
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10004641A Issued in IN
Practice address
909 Sagamore Pkwy W
West Lafayette, IN 47906-1443
Phone
(765) 463-6262
NPI assigned
Oct 11, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Physician Assistant 363A00000X 10004641A IN Primary

Addresses

Primary practice location

909 Sagamore Pkwy W
West Lafayette, IN 47906-1443

Mailing address

PO Box 781076
Detroit, MI 48278-1076
Phone (317) 528-4800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250318000895 IN Practitioner - Physician Assistant 4981126117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Practice addresses (Care Compare)

150 W Washington St
Shelbyville, IN 46176-1236
Phone (317) 865-5904

909 Sagamore Pkwy W
West Lafayette, IN 47906-1443
Phone (765) 463-6262

915 Sagamore Pkwy W
West Lafayette, IN 47906-1443
Phone (765) 463-9979

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10004641AINMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Physician Network CurrentSince Apr 6, 2025 Accepting new patients
Franciscan Physician Network CurrentSince Apr 6, 2025 Accepting new patients

Locations

1704 Lafayette Rd
Ste 4
Crawfordsvlle, IN 47933
Phone (765) 364-3120

150 W Washington St
Shelbyville, IN 46176
Phone (317) 392-3211

909 Sagamore Pkwy W
West Lafayette, IN 47906
Phone (765) 463-6262

Organizations & group practices 3

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": "1728604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1023838455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 SAGAMORE PKWY W",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061443",
            "telephone_number": "765-463-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDO",
        "first_name": "ZACHARY",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-11",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004641A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Lafayette, IN

Sources for this page

Verify at the official NPI Registry.