Individual provider Active NPI

Jaime Santos Medina

  • Behavior Technician
  • Pembroke Pines, FL
National Provider Identifier
1356940241
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
RBT-20-138120 Issued in FL
Practice address
1881 NW 123Rd Ave
Pembroke Pines, FL 33026-3825
Phone
(954) 589-5697
NPI assigned
Oct 21, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-20-138120 FL Primary

Addresses

Primary practice location

1881 NW 123Rd Ave
Pembroke Pines, FL 33026-3825

Mailing address

2514 Adams St
Hollywood, FL 33020-5325
Phone (786) 499-7778

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

LicenseStateTypeSpecialty
RBT-20-138120FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Rescatadores de Angeles, LLC. CurrentSince Oct 25, 2020 Accepting new patients

Locations

1881 NW 123rd Ave
Pembroke Pines, FL 33026
Phone (954) 589-5697

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1356940241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 ADAMS ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330205325",
            "telephone_number": "786-499-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1881 NW 123RD AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263825",
            "telephone_number": "954-589-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS MEDINA",
        "first_name": "JAIME",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-20-138120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.