NPIMap

Individual provider Active NPI

Carlo Medina, M.D.

  • Internal Medicine Physician
  • Marina del Rey, CA
National Provider Identifier
1093786444
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C53912 Issued in CA
Practice address
4560 Admiralty Way Ste 201
Marina del Rey, CA 90292-5425
Phone
(310) 823-3443
Fax
(310) 305-7470
NPI assigned
Feb 1, 2006
Last updated
May 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X C53912 CA
Internal Medicine Physician 207R00000X C53912 CA Primary

Addresses

Primary practice location

4560 Admiralty Way Ste 201
Marina del Rey, CA 90292-5425

Mailing address

1626 Montana Ave # 631
Santa Monica, CA 90403-1808
Phone (310) 823-3443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100630000706 CA Practitioner - HospitalistPractitioner - Internal Medicine 6901818087 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
JS Weill Medical College, Cornell University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kansal IncGroup PAC ID 6406089739, 18 clinicians

Practice addresses (Care Compare)

1426 Montana Ave
Suite 2
Santa Monica, CA 90403-1763
Phone (310) 388-6798

4650 Lincoln Blvd
Marina del Rey, CA 90292-6306
Phone (800) 233-2771

8700 Beverly Blvd
West Hollywood, CA 90048-1804
Phone (310) 423-3277

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C53912CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kansal Inc Internal Medicine CurrentSince Dec 1, 2017 Accepting new patients
Carlo Medina Medical Corporation Internal Medicine CurrentSince Aug 16, 2022 Accepting new patients
Cogent Healthcare of Washington, PC Internal Medicine CurrentSince Jan 1, 2021 Accepting new patients
Harold Cardinal Valery M.D. Inc. Past Accepting new patients
Keck Medical Center of Usc Past Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Cedars-Sinai Marina Hospital Past Accepting new patients

Locations

1655 S Western Ave
Los Angeles, CA 90006
Phone (323) 737-5200

5900 W Olympic Blvd
Los Angeles, CA 90036
Phone (310) 267-2680

4560 Admiralty Way
Ste 201
Marina del Rey, CA 90292
Phone (310) 577-7555

1426 Montana Ave
Ste 2
Santa Monica, CA 90403
Phone (310) 388-6798

1626 Montana Ave
#631
Santa Monica, CA 90403

8700 Beverly Blvd
West Hollywood, CA 90048
Phone (310) 385-3291

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 9

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.

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1093786444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 MONTANA AVE # 631",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904031808",
            "telephone_number": "310-823-3443",
            "fax_number": "310-305-7470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 ADMIRALTY WAY STE 201",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925425",
            "telephone_number": "310-823-3443",
            "fax_number": "310-305-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "CARLO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "C53912",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C53912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marina del Rey, CA

Sources for this page

Verify at the official NPI Registry.