NPIMap

Individual provider Active NPI

Edwin Medina, M.D.

  • Family Medicine Physician
  • Malta, MT
National Provider Identifier
1356487201
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9635 Issued in MT
Practice address
830 S Central Ave
Malta, MT 59538
Phone
(406) 390-2596
Fax
(406) 654-2571
NPI assigned
Jan 29, 2007
Last updated
Jan 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9635 MT Primary

Addresses

Primary practice location

830 S Central Ave
Malta, MT 59538

Mailing address

PO Box 1235
Malta, MT 59538-1235
Phone (406) 301-1063

Other identifiers 3

IdentifierTypeStateIssuer
000092611OtherMTBLUE CROSS BLUE SHIELD
0028223MedicaidMT
0720001MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091109000510 MT Practitioner - Family PracticePractitioner - General Practice 1254234420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

830 Central Ave
Malta, MT 59538
Phone (406) 654-2878

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9635MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Malta Medical Associates, LLC Family Medicine CurrentSince Apr 7, 2022 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: emedina@mma-mt.direct.office.nextgen.com
  • Direct secure messaging: maltamedicalassociates.edwinmedina@161558.advancedmd-direct.com

Organizations & group practices 2

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1356487201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1235",
            "city": "MALTA",
            "state": "MT",
            "postal_code": "595381235",
            "telephone_number": "406-301-1063",
            "fax_number": "406-654-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S CENTRAL AVE",
            "city": "MALTA",
            "state": "MT",
            "postal_code": "59538",
            "telephone_number": "406-390-2596",
            "fax_number": "406-654-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2023-01-18",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "9635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000092611",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028223",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0720001",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Malta, MT

Sources for this page

Verify at the official NPI Registry.