Phillip A Medina, MD

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

MD00028329 Issued in WA

Practice address

4361 Talbot Road S
#102
Renton, WA 98055

Phone

(425) 226-1180

Fax

(425) 235-0695

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Phillip a Medina MD Inc PS

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Renton, WA
  • NPI 1629194550
  NPD (past) Authorized official

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1720040371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4361 TALBOT ROAD S",
            "address_2": "#102",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98055",
            "telephone_number": "425-226-1180",
            "fax_number": "425-235-0695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4361 TALBOT ROAD S",
            "address_2": "#102",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98055",
            "telephone_number": "425-226-1180",
            "fax_number": "425-235-0695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "PHILLIP",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WA",
            "license": "MD00028329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica E McMurdie, OTR/L
• Dave McNamara
• Shannon Danelle McPherson, LMP
• Stephanie Meade, RPH
• Nohemi Medina Castillo
• Medisquad LLC
• Jessica Medrala, DNP, ARNP
• Margaret Victoria Mehl, PHARMD.
• Amisha Mehta, MD
• Girmachew Tefera Mekonnnen, RRT

• Sports Medicine (Orthopaedic Surgery) Physician in Renton, WA
• Providers in Renton, WA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; 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.