Manuel Medina III, PAC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA13808 Issued in CA

Practice address

610 W 17TH St
Santa Ana, CA 92706-3621

Phone

(714) 541-4090

Fax

(714) 541-8815

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Sa Medical Center Inc.

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1851423925
  Medicare reassignment

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952498867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 W 17TH ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927063621",
            "telephone_number": "714-541-4090",
            "fax_number": "714-541-8815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W 17TH ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927063621",
            "telephone_number": "714-541-4090",
            "fax_number": "714-541-8815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "MANUEL",
        "name_suffix": "III",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA13808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irlanda Medina
• Katherine Ivonne Medina
• Leslie Diane Medina
• Linda Medina
• Linda Ruby Medina, PA-C
• Margarita Rosario Medina
• Myra Alexandra Medina, AMFT
• Priscilla Medina, PTA
• Roger Medina
• Shawn Michael Medina

• Family Medicine Physician in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.