Camille Ivy Medina

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95034074 Issued in CA

Practice address

100 W California Blvd
Pasadena, CA 91105-3010

Phone

(626) 397-5000

NPI assigned

May 20, 2025

Last updated

May 20, 2025By the provider in NPPES

Sex

Unspecified or another gender identity

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

National University of Arts and Sciences, Medical Department, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Huntington Medical FoundationGroup PAC ID 4587631601, 46 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Huntington Hospital Hospital, Pasadena, CA, CCN 050438

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Huntington Medical Foundation

  dba Huntington Health Physicians

  • Internal Medicine Physician
  • Pasadena, CA
  • NPI 1154467181

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pasadena Hospital Association, LTD

  dba Huntington Hospital

  • General Acute Care Hospital
  • Pasadena, CA
  • NPI 1407828429
  Care Compare affiliation

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

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1033901582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W CALIFORNIA BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W CALIFORNIA BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053010",
            "telephone_number": "626-397-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "CAMILLE",
        "middle_name": "IVY",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95034074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medical Support Los Angeles a Medical Corp
• Medical Support Los Angeles a Medical Corporation
• Omar de Jesus Medina Martinez
• Noemi Medina-Lee
• Aida Marlene Medina
• Cynthia Medina, BCBA
• Diana Jeannette Medina, RPT
• Erika Medina, ASW
• Gabby Medina
• Genesis Medina

• Psychiatric/Mental Health Nurse Practitioner in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.