Active NPI
Edwin Medina, M.D.
- Family Medicine Physician
- Malta, MT
National Provider Identifier
1356487201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 9635
- Practice address
- 830 S Central Ave
Malta, MT 59538 - Phone
- (406) 390-2596
- Fax
- (406) 654-2571
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0028223 | Medicaid | MT | |
| 000092611 | Other | MT | BLUE CROSS BLUE SHIELD |
| 0720001 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091109000510 | MT | Practitioner - Family 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
- Phillips County Hospital - Cah
- Northern Montana Hospital
- Billings Clinic Hospital
- Frances Mahon Deaconess Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 12 |
| Removal of nail tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9635 | MT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Malta Medical Associates, LLC | Family Medicine | Current | Accepting new patients |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Interoperability endpoints
- maltamedicalassociates.edwinmedina@161558.advancedmd-direct.com
- emedina@mma-mt.direct.office.nextgen.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 and National Provider Directory roles.
-
- Family Medicine Physician
- Malta, MT
- NPI 1528716370
Family Medicine, MT
-
- Critical Access Hospital
- Glasgow, MT
- NPI 1689685323
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": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0028223",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000092611",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0720001",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Malta, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; 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.
- 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.