Roberto Eduardo Medina, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

29919 Issued in OK

Practice address

309 Jackson St
Monroe, LA 71201-7407

Phone

(806) 831-8734

Fax

(940) 205-5028

NPI assigned

Jun 11, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Emergency Services of Oklahoma PC

  • Emergency Medicine Physician
  • Norman, OK
  • NPI 1215249891
  Medicare reassignment NPD
• Iacc/Ehi NW, LLC

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1194209155
  NPD (past)
• Iacc/Ehi NW, LLC

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1336623198
  NPD (past)
• Iacc/Ehi NW, LLC

  • General Acute Care Hospital
  • Moore, OK
  • NPI 1447734272
  NPD (past)
• Iacc/Ehi NW, LLC

  • General Acute Care Hospital
  • Del City, OK
  • NPI 1942784715
  NPD (past)

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1063850147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 JACKSON ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017407",
            "telephone_number": "806-831-8734",
            "fax_number": "402-055-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 JACKSON ST",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017407",
            "telephone_number": "806-831-8734",
            "fax_number": "940-205-5028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12420 Milestone Center Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "MD",
            "postal_code": "208767111",
            "country_code": "US",
            "telephone_number": "240-686-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "ROBERTO",
        "middle_name": "EDUARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-11",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "311630",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "BP10045433",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "OK",
            "license": "29919",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "BP10045433",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "29919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph McQuarn
• Benjamin Lynn McRae, PT
• Wendi S McVay, FNP
• Valerie Camille Meche Roark, M.S., CCC-SLP
• Medical Technology of Louisiana LLC
• Medistar Home Health of Monroe, L.L.C.
• Mark Megaly, MD
• James Mejias, M.A., PLPC
• Melissa Mejias, M.S., LPC
• Melanie Massey Physical Therapy Inc

• Emergency Medicine Physician in Monroe, LA
• Providers in Monroe, LA by specialty
• Emergency Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.