NPIMap

Individual provider Active NPI

Monique Medina, PA

  • Physician Assistant
  • Ormond Beach, FL
National Provider Identifier
1467967240
Registry record updated Dec 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9110897 Issued in FL
Practice address
77 W Granada Blvd
Ormond Beach, FL 32174-6302
Phone
(386) 677-0453
NPI assigned
Dec 3, 2017
Last updated
Dec 3, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9110897 FL Primary

Addresses

Primary practice location

77 W Granada Blvd
Ormond Beach, FL 32174-6302

Mailing address

245 Sands Parc Blvd Apt 412
Daytona Beach, FL 32117-0061

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20180131000351 FL Practitioner - Physician Assistant 7012277668 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ormond Medical ArtsGroup PAC ID 1254222565, 38 clinicians

Practice addresses (Care Compare)

346 N Ridgewood Ave
Suite a
Edgewater, FL 32132-1672
Phone (386) 423-1888

77 W Granada Blvd
Ormond Beach, FL 32174-6302
Phone (904) 677-0453

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9110897FLMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: monique.medina.1@15135.direct.athenahealth.com
  • Direct secure messaging: monique.medina.1@1579.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1512259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512259200000",
    "number": "1467967240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 SANDS PARC BLVD APT 412",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321170061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W GRANADA BLVD",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321746302",
            "telephone_number": "386-677-0453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MONIQUE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-03",
        "last_updated": "2017-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9110897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

Verify at the official NPI Registry.