Robert M Medina, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10207 Issued in CA

Practice address

390 North Loop Road
Fort Irwin, CA 92310-5109

Phone

(760) 383-5289

Fax

(760) 383-5128

NPI assigned

May 25, 2006

Last updated

Jan 26, 2024By the provider in NPPES

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • West Covina, CA
  • NPI 1346614054
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1235185190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 NORTH LOOP ROAD",
            "city": "FORT IRWIN",
            "state": "CA",
            "postal_code": "923105109",
            "telephone_number": "760-383-5289",
            "fax_number": "760-383-5128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 NORTH LOOP ROAD",
            "city": "FORT IRWIN",
            "state": "CA",
            "postal_code": "923105109",
            "telephone_number": "760-383-5289",
            "fax_number": "760-383-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "ROBERT",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA10207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Jean Mays, LPN
• Ashley Marie McAlinden, LVN
• Moira McCormack, PA-C
• Sarah Laine McDonald, LPN
• Meddac-Wach
• Ethel Cortez Mijares, DENTAL ASSISTANT
• Alan Josiah Mills II, DENTAL ASST 68EX2
• Sonja Christine Morales, LPN
• Jessica Ann Moreland, RN
• Lendilla Yvonne Morris Caldwell, LPCC, LCDC, CPC, LPC

• Physician Assistant in Fort Irwin, CA
• Providers in Fort Irwin, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.