Alan Medina, MD PA
Organization Active NPI Psychiatry Physician · Palm Coast, FL
NPI 1548545809 · NPPES record last updated Aug 14, 2021
Key facts
- NPI
- 1548545809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- ALAN MEDINA, MD PA
- Practice address
- 19 New Water Oak Dr
Palm Coast, FL 32137-6958 - Phone
- (917) 856-6519
- Fax
- (386) 597-2948
- NPI assigned
- Oct 19, 2011
- Organization subpart
- No
Authorized official
- Name
- Alan Medina, MD
- Title
- President
- Phone
- (917) 856-6519
Practitioners 1
-
Alan Medina, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210805000931 | FL | Part B Supplier - Clinic/Group Practice | 2163826652 |
Receives reassigned benefits from 1 practitioner Practice locations: Palm Coast, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes | ||
| Medical Specialty Clinic/Center | 261QM2500X | 170738 | NY |
Addresses
Primary practice location
19 New Water Oak Dr
Palm Coast, FL 32137-6958
Mailing address
19 New Water Oak Dr
Palm Coast, FL 32137-6958
Phone (917) 856-6519
Other providers in Palm Coast, FL
- Roz Aghaaliandastjerdi
- Jennifer Marie Agosto
- Sarai Aguiar Ugalde
- Tanam Ahmed
- Oluwatosin Adesola Ajayi
- David F. Alaniz
- Ahmad Samer Alawad
- Albertsons LLC
- Craig Joseph Alexander
- Alexandra Kostick MD PA
All providers in Palm Coast, FL · Psychiatry Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.