Jacob Medina, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

244459 Issued in NY

Practice address

85 Gelston St
Buffalo, NY 14213-1524

Phone

(716) 533-7175

NPI assigned

Jul 13, 2012

Last updated

Jul 13, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1245585470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 GELSTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131524",
            "telephone_number": "716-533-7175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 GELSTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131524",
            "telephone_number": "716-533-7175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "244459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING LICENSE",
            "identifier": "244459",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Medfirst Urgent Care PLLC
• Medfirst Urgent Care PLLC
• Kristin Mediak
• Medical Practitioner Services of Wny PC
• Deidre Medina, L.M.T.
• Victoria Medley, LMSW
• Kellsey G Medsger, PA
• Ian Medus, M.D.
• Andria Meeder, M.S.
• Jenna Marie Meehan, PA-C

• Licensed Practical Nurse in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.