Active NPI
Roberto E Medina, CCP
- Perfusionist
- Las Cruces, NM
National Provider Identifier
1356525091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- PF0495
- Practice address
- 4604 Sandalwood Dr
Las Cruces, NM 88011-9627 - Phone
- (505) 522-2418
- NPI assigned
- Dec 18, 2007
- Last updated
- Dec 18, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Perfusionist | 242T00000X | PF0495 | TX | Primary |
Addresses
Primary practice location
4604 Sandalwood Dr
Las Cruces, NM 88011-9627
Mailing address
4604 Sandalwood Dr
Las Cruces, NM 88011-9627
Phone (505) 522-2418
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PF0495 | TX | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197936000000",
"number": "1356525091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4604 SANDALWOOD DR",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880119627",
"telephone_number": "505-522-2418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4604 SANDALWOOD DR",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880119627",
"telephone_number": "505-522-2418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "ROBERTO",
"middle_name": "E",
"credential": "CCP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-18",
"last_updated": "2007-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "TX",
"license": "PF0495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.