Active NPI
Stephanie Medina, ATC
- Athletic Trainer
- West Lafayette, IN
National Provider Identifier
1760869358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 900 N John R Wooden Dr
West Lafayette, IN 47907-2117 - Phone
- (931) 237-1404
- NPI assigned
- May 3, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | 287005 | TN | |
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
900 N John R Wooden Dr
West Lafayette, IN 47907-2117
Mailing address
4421 Crossbow CT
West Lafayette, IN 47906-7117
Phone (931) 237-1404
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 287005 | TN | MD | Sports Medicine (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720483200000",
"number": "1760869358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4421 CROSSBOW CT",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479067117",
"telephone_number": "931-237-1404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 N JOHN R WOODEN DR",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479072117",
"telephone_number": "931-237-1404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "STEPHANIE",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-03",
"last_updated": "2024-07-09",
"certification_date": "2024-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207PS0010X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Sports Medicine",
"state": "TN",
"license": "287005",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.