Active NPI
Carlos Alfredo Medina, M.D.
- Pediatric Pulmonology Physician
- Frisco, TX
National Provider Identifier
1972554954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Pulmonology Physician
- License
- L8430
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 168602402 | Medicaid | TX | |
| 8U3552 | Other | TX | BLUE CROSS BLUE SHIELD |
| 168602401 | Medicaid | TX |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L8430 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Health Care, P.L.L.C. | Current | Accepting new patients | |
| Texas Health Care, P.L.L.C. | Current | Accepting new patients | |
| Texas Health Care, P.L.L.C. | Current | 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
- 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.
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-
- Family Medicine Physician
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- NPI 1821026352
-
- Specialist
- Frisco, TX
- NPI 1417095415
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; 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.