Ekaterina Medina, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

13546 Issued in FL

Practice address

14866 Old Saint Augustine Rd Ste 103
Jacksonville, FL 32258-2611

Phone

(904) 348-0039

NPI assigned

Jul 7, 2021

Sex

Female

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 FL

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - Davenport, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revolution Chiropractic LLCGroup PAC ID 2163701145, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Revolution Chiropractic LLC

  • Chiropractor
  • Jacksonville, FL
  • NPI 1124576566
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1275104697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PITTMAN PL",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321644838",
            "telephone_number": "386-237-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14866 OLD SAINT AUGUSTINE RD STE 103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582611",
            "telephone_number": "904-348-0039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "EKATERINA",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-07",
        "last_updated": "2023-08-14",
        "certification_date": "2022-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "13546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Medina-Dobbs, 390200000X
• Marcelle Medina-Smester
• Beth Ann Medina
• Daniela Medina
• Edgar C Medina
• Flavia C Medina, D.C.
• Humberto Medina, PT
• Jazmyn Mireya Medina
• Jessica Marie Medina
• Joseph Michael Medina, DMD

• Chiropractor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.