Individual provider Active NPI

Manuel Medina, MD

  • Anesthesiology Physician
  • Staten Island, NY
National Provider Identifier
1629004700
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
237891 Issued in NY
Practice address
355 Bard Ave
Staten Island, NY 10310
Phone
(718) 818-1234
NPI assigned
Jun 23, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 237891 NY Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310

Mailing address

3733 Richmond Ave
Staten Island, NY 10312
Phone (718) 948-6177

Other identifiers 1

IdentifierTypeStateIssuer
02694700MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051010000836 NY Practitioner - Anesthesiology 0749205623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University Central del Caribe Escuela de Medicina, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North American Partners in Anesthesia LLPGroup PAC ID 7719885771, 427 clinicians

Practice addresses (Care Compare)

355 Bard Ave
Staten Island, NY 10310-1664
Phone (718) 818-1234

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
237891NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia LLP Anesthesiology CurrentSince Jul 3, 2022 Accepting new patients

Locations

7 Southwoods Blvd
Ste 4
Albany, NY 12211

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

1510 Jericho Tpke
New Hyde Park, NY 11040
Phone (516) 216-5341

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

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 1

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629004700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3733 RICHMOND AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10312",
            "telephone_number": "718-948-6177",
            "fax_number": "718-948-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10310",
            "telephone_number": "718-818-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MANUEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "237891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02694700",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.