Individual provider Active NPI

Jody Medvedik, M.S.,CCC-A

  • Audiologist
  • Lansing, MI
National Provider Identifier
1851413462
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
000358 Issued in MI
Practice address
120 N Washington SQ Ofc 378
Lansing, MI 48933-1617
Phone
(888) 964-6681
Fax
(888) 662-0859
NPI assigned
Apr 4, 2007
Last updated
Nov 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X A.02414 OH
Audiologist 231H00000X 000358 MI Primary

Addresses

Primary practice location

120 N Washington SQ Ofc 378
Lansing, MI 48933-1617

Mailing address

100 Crossing Blvd Ste 300
Framingham, MA 01702-5555
Phone (617) 964-6681

Other practice location 1

20 S 3rd St Ste 210
Columbus, OH 43215-4206
Phone (888) 964-6681

Other identifiers 2

IdentifierTypeStateIssuer
640H224420OtherMIBCBSM NUMBER
804741233MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050613001247 MI Practitioner - Qualified Audiologist 7911941737 Reassigns benefits to 1 organization
I20221017001957 OH Practitioner - Qualified Audiologist 7911941737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mobile Audiology Associates PCGroup PAC ID 3678465283, 26 clinicians
Healthdrive Audiology CorporationGroup PAC ID 0446203962, 9 clinicians

Practice addresses (Care Compare)

120 N Washington SQ
Ofc 378
Lansing, MI 48933-1617
Phone (888) 964-6681

655 Metro PL S
Suite 600
Dublin, OH 43017-3394
Phone (888) 964-6681

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
000358MIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthdrive Audiology Corporation Audiologist CurrentSince Sep 8, 2022 Accepting new patients
Mobile Audiology Associates, P.C. Audiologist CurrentSince Sep 1, 2021 Accepting new patients
Ddymon Inc. Past Accepting new patients
Great Lakes Hearing Care Audiologist PastSince Sep 25, 2022 Accepting new patients

Locations

100 Crossing Blvd
Ste 300
Framingham, MA 01702
Phone (857) 255-0486

655 Metro Pl S
Ste 600
Dublin, OH 43017
Phone (614) 323-3578

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1851413462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CROSSING BLVD STE 300",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "017025555",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N WASHINGTON SQ OFC 378",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489331617",
            "telephone_number": "888-964-6681",
            "fax_number": "888-662-0859"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 S 3rd St Ste 210",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432154206",
            "country_code": "US",
            "telephone_number": "888-964-6681",
            "fax_number": "888-662-0859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDVEDIK",
        "first_name": "JODY",
        "credential": "M.S.,CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OH",
            "license": "A.02414",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "000358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM NUMBER",
            "identifier": "640H224420",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804741233",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.