Active NPI
Cristina Nicolas Medrano, MD
- Surgery Physician
- Champaign, IL
National Provider Identifier
1720242209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 036100823
- Practice address
- 507 S 2ND St
Unit 1- South East
Champaign, IL 61820-5428 - Phone
- (217) 722-3087
- NPI assigned
- Jul 15, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036100823 | IL | Primary |
Addresses
Primary practice location
507 S 2ND St
Unit 1- South East
Champaign, IL 61820-5428
Mailing address
507 S 2ND St
Unit 1- South East
Champaign, IL 61820-5428
Phone (217) 722-3087
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036100823 | IL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216080000000",
"number": "1720242209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 S 2ND ST",
"address_2": "UNIT 1- SOUTH EAST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618205428",
"telephone_number": "217-722-3087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "507 S 2ND ST",
"address_2": "UNIT 1- SOUTH EAST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618205428",
"telephone_number": "217-722-3087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDRANO",
"first_name": "CRISTINA",
"middle_name": "NICOLAS",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-15",
"last_updated": "2008-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036100823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.