Michael L. Medvin, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

G67405 Issued in CA

Practice address

1287 Fulton Rd
Santa Rosa, CA 95401-4923

Phone

(707) 888-5808

Fax

(707) 577-8315

NPI assigned

May 9, 2006

Sex

Male

Sole proprietor

No

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Michael D Phillips, MD Medical Corporation

  • Pain Medicine Physician
  • Los Angeles, CA
  • NPI 1932445012

  Emergency Medicine

  NPD (past)
• Pacific Redwood Medical Group Inc

  • Emergency Medicine Physician
  • Ukiah, CA
  • NPI 1033103676
  NPD (past)

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361750400000",
    "number": "1174572952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 CALISTOGA RD. #343",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95409",
            "telephone_number": "707-888-5808",
            "fax_number": "707-577-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1287 FULTON RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014923",
            "telephone_number": "707-888-5808",
            "fax_number": "707-577-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDVIN",
        "first_name": "MICHAEL",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2013-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G67405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medina & Oliva Dental PC
• Cesar Ulyces Medina, PT
• Ivan Medina
• Kayla Elyse Medina, NP
• Loi C Medvin, M.A., PSY.D.
• Avery Meek
• Stephen Meffert, M.D.
• Mehdipour DMD PC
• Navid Mehdipour
• Ketan C Mehta, M.D.

• Emergency Medicine Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; 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.