Lissette M Medina, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9105170 Issued in FL

Practice address

3100 SW 62ND Ave
Miami, FL 33155-3009

Phone

(305) 662-8366

NPI assigned

Mar 12, 2012

Sex

Female

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 FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Baptist Health Medical Group Orthopedics, LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Coral Gables, FL
  • NPI 1700072535
  Medicare reassignment NPD
• Public Health Trust of Miami Dade County Florida

  • General Practice Physician
  • Miami, FL
  • NPI 1134384423
  Medicare reassignment NPD (past)
• Baptist Health Medical Group Orthopedics, LLC

  • Durable Medical Equipment & Medical Supplies
  • Miami Gardens, FL
  • NPI 1386333144
  NPD
• Public Health Trust of Miami Dade County Florida

  • General Practice Physician
  • Miami, FL
  • NPI 1639822281
  NPD
• Public Health Trust of Miami Dade County Florida

  • General Practice Physician
  • Hialeah, FL
  • NPI 1841149093
  NPD

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

{
    "created_epoch": "1331510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331510400000",
    "number": "1154696011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-662-8366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-662-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "LISSETTE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-12",
        "last_updated": "2012-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9105170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karla Amanda Medina
• Kathya M Medina, PHARM. D.
• Lazara Medina
• Lien Medina
• Lisandra Medina
• Lourdes De la Caridad Medina
• Luis S Medina, MD
• Marcela Medina
• Maricel Medina
• Mario Medina, ARNP

• Surgical Physician Assistant in Miami, FL
• Providers in Miami, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; 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.