Individual provider Active NPI

Minda Trujillo, PA-C

  • Physician Assistant
  • Columbus, GA
National Provider Identifier
1164809901
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11744 Issued in GA
Practice address
100 Frist CT
Columbus, GA 31909-3578
Phone
(202) 288-5046
NPI assigned
Apr 30, 2015
Last updated
Dec 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11744 GA Primary

Addresses

Primary practice location

100 Frist CT
Columbus, GA 31909-3578

Mailing address

22 Lee Road 612
Smiths Station, AL 36877-2042
Phone (202) 288-5046

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180424000749 OH Practitioner - Physician Assistant 6204157795 Reassigns benefits to 3 organizations
I20231011003963 GA Practitioner - Physician Assistant 6204157795 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11744GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System CurrentSince Jun 23, 2019 Accepting new patients

Locations

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

4229 Pearl Rd
Cleveland, OH 44109
Phone (216) 459-6300

Interoperability endpoints

  • Direct secure messaging: mwallace39781@ehrdirect.uhhospitals.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1164809901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 LEE ROAD 612",
            "city": "SMITHS STATION",
            "state": "AL",
            "postal_code": "368772042",
            "telephone_number": "202-288-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 FRIST CT",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319093578",
            "telephone_number": "202-288-5046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRUJILLO",
        "first_name": "MINDA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-30",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.