Individual provider Active NPI

Jose Sebastian Medina, MD

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1821551748
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A184665 Issued in CA
Practice address
1414 S Grand Ave Ste 200
Los Angeles, CA 90015-3072
Phone
(213) 419-9600
Fax
(213) 419-9900
NPI assigned
Apr 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A184665 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1414 S Grand Ave Ste 200
Los Angeles, CA 90015-3072

Mailing address

2550 W Main St Ste 301
Alhambra, CA 91801-7003
Phone (213) 419-9600

Other practice location 1

833 Chestnut St Ste 301
Philadelphia, PA 19107-4405
Phone (215) 955-7190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20220614000365 PA Practitioner - Family Practice 1153654199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rutgers New Jersey Medical School, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

1101 Chestnut St
Philadelphia, PA 19107-3619
Phone (800) 533-3669

111 S 11TH St
Philadelphia, PA 19107-4824

834 Walnut St
Suite 110
Philadelphia, PA 19107-5109
Phone (215) 503-4779

925 Chestnut St
Philadelphia, PA 19107-4204

925 Chestnut St
Suite 3
Philadelphia, PA 19107-4216
Phone (215) 955-8874

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A184665CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Family Medicine CurrentSince Jul 1, 2022 Accepting new patients

Locations

833 Chestnut St
Ste 301
Philadelphia, PA 19107
Phone (215) 955-2363

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701993600000",
    "number": "1821551748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 W MAIN ST STE 301",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918017003",
            "telephone_number": "213-419-9600",
            "fax_number": "213-419-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 S GRAND AVE STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153072",
            "telephone_number": "213-419-9600",
            "fax_number": "213-419-9900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "833 Chestnut St Ste 301",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074405",
            "country_code": "US",
            "telephone_number": "215-955-7190",
            "fax_number": "215-955-8600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JOSE",
        "middle_name": "SEBASTIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A184665",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.