NPIMap

Individual provider Active NPI

Jonathon Dominique Medina, M.D.

  • Family Medicine Physician
  • Cheyenne, WY
National Provider Identifier
1942219803
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
7156A Issued in WY
Practice address
1950 Bluegrass Cir Ste 200
Cheyenne, WY 82009-7364
Phone
(307) 778-2577
Fax
(307) 635-2131
NPI assigned
Aug 7, 2006
Last updated
Oct 31, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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 43517 CO
Family Medicine Physician 207Q00000X 7156A WY Primary

Addresses

Primary practice location

1950 Bluegrass Cir Ste 200
Cheyenne, WY 82009-7364

Mailing address

1950 Bluegrass Cir Ste 200
Cheyenne, WY 82009-7364
Phone (307) 778-2577

Other identifiers 1

IdentifierTypeStateIssuer
01727541MedicaidCO

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jmedina3808@direct.crmcwy.org Direct Memorial Hospital of Laramie County
Direct Messaging Address jmedina3808@direct.crmcwy.org Health Information Exchange (HIE) Memorial Hospital of Laramie County

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110929000071 WY Practitioner - Family Practice 0941235675 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cheyenne Regional Physicians Group LLCGroup PAC ID 2961403639, 101 clinicians
University of WyomingGroup PAC ID 4183607054, 40 clinicians

Practice addresses (Care Compare)

1950 Bluegrass Cir
Suite 200
Cheyenne, WY 82009-7364
Phone (307) 778-2577

820 E 17TH St
Cheyenne, WY 82001-4714
Phone (307) 431-5055

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7156AWYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wyoming Speech and Hearing Clinic CurrentSince Jul 3, 2012 Accepting new patients
University of Wyoming Family Medicine CurrentSince Jul 3, 2012 Accepting new patients
Cheyenne Regional Physicians Group, LLC Family Medicine CurrentSince Aug 25, 2011 Accepting new patients
University of Wyoming Family Medicine Current Accepting new patients
Cheyenne Children's Clinic, PC Past Accepting new patients
Cheyenne Regional Physicians Group, LLC PastSince Dec 12, 2021 Accepting new patients
University of Wyoming Family Medicine Past Accepting new patients

Locations

1950 Bluegrass Cir
Ste 200
Cheyenne, WY 82009
Phone (307) 778-2577

214 E 23rd St
Cheyenne, WY 82001
Phone (307) 324-2221

4116 Laramie St
Cheyenne, WY 82001
Phone (307) 634-9311

820 E 17th St
Cheyenne, WY 82001
Phone (307) 431-5055

Interoperability endpoints

  • Direct secure messaging: jmedina3808@direct.crmcwy.org
  • Direct secure messaging: jonathan.medina.1@30244.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1942219803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 BLUEGRASS CIR STE 200",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820097364",
            "telephone_number": "307-778-2577",
            "fax_number": "307-635-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 BLUEGRASS CIR STE 200",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820097364",
            "telephone_number": "307-778-2577",
            "fax_number": "307-635-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JONATHON",
        "middle_name": "DOMINIQUE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "43517",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "7156A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01727541",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmedina3808@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Memorial Hospital of Laramie County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "214 E 23rd St",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmedina3808@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Memorial Hospital of Laramie County",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "214 E 23rd St",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.