Individual provider Active NPI

Carlos Alfredo Medina, M.D.

  • Pediatric Pulmonology Physician
  • Frisco, TX
National Provider Identifier
1972554954
Registry record updated Jan 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
L8430 Issued in TX
Practice address
8501 Wade Blvd
BLDG. X, Suite 1020
Frisco, TX 75034-5894
Phone
(972) 668-5864
Fax
(972) 668-5825
NPI assigned
May 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X L8430 TX
Pediatric Pulmonology Physician 2080P0214X L8430 TX Primary

Addresses

Primary practice location

8501 Wade Blvd
BLDG. X, Suite 1020
Frisco, TX 75034-5894

Mailing address

8501 Wade Blvd
BLDG. X, Suite 1020
Frisco, TX 75034-5894
Phone (972) 668-5864

Other identifiers 3

IdentifierTypeStateIssuer
168602402MedicaidTX
8U3552OtherTXBLUE CROSS BLUE SHIELD
168602401MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20040930000175 TX Practitioner - Pediatric Medicine 1951370535 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L8430TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Care, P.L.L.C. CurrentSince Aug 15, 2023 Accepting new patients
Texas Health Care, P.L.L.C. Current Accepting new patients
Texas Health Care, P.L.L.C. CurrentSince Aug 15, 2023 Accepting new patients
Pediatric Pulmonary Assoc. of N. Texas Past Accepting new patients

Locations

8501 Wade Blvd
Ste 1020
Frisco, TX 75034
Phone (972) 668-5864

920 Santa Fe Dr
Ste 103
Weatherford, TX 76086
Phone (817) 339-8855

Interoperability endpoints

  • Direct secure messaging: cmedina22138@direct.childrens.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453334400000",
    "number": "1972554954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8501 WADE BLVD",
            "address_2": "BLDG. X, SUITE 1020",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750345894",
            "telephone_number": "972-668-5864",
            "fax_number": "972-668-5825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 WADE BLVD",
            "address_2": "BLDG. X, SUITE 1020",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750345894",
            "telephone_number": "972-668-5864",
            "fax_number": "972-668-5825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "CARLOS",
        "middle_name": "ALFREDO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2016-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L8430",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "TX",
            "license": "L8430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168602402",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8U3552",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168602401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frisco, TX

Sources for this page

Verify at the official NPI Registry.