Santiago Eli Medina

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

17361 Issued in PR

Practice address

Carr 844 KM 4.2
Cupey Bajo
San Juan, PR 00926

Phone

(787) 760-0770

Fax

(787) 998-4415

NPI assigned

Oct 9, 2008

Last updated

Oct 15, 2015By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• San Juan Primary Health Care Providers, LLC

  • Primary Care Clinic/Center
  • San Juan, PR
  • NPI 1235411711
  Medicare reassignment

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

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444867200000",
    "number": "1881845782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "LE93 VIA PARIS",
            "address_2": "L ANTIGUA",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "009765414",
            "telephone_number": "787-585-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 844 KM 4.2",
            "address_2": "CUPEY BAJO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-760-0770",
            "fax_number": "787-998-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "SANTIAGO",
        "middle_name": "ELI",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-09",
        "last_updated": "2015-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "17361",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margarita Medina, M.D.
• Maria A Medina, REGISTER NURSE
• Maritza Medina
• Melanie Diane Medina, MD, MBA
• Nicole Medina, PHARMD
• Victor Gabriel Medina
• Victor Luis Medina, M.D.
• Yamil Malave Medina, PSY, D.
• Medipeds LLC
• Mediser-Mefdicina Interna, Corp.

• General Practice Physician in San Juan, PR
• Providers in San Juan, PR by specialty
• General Practice Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.