Jose Medina, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1575 Issued in OK

Practice address

4300 W Memorial Rd
ER Dept
Oklahoma City, OK 73120-8304

Phone

(405) 752-3733

Fax

(405) 749-4557

NPI assigned

Feb 6, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jose.medina.1@17619.direct.athenahealth.com
• Direct secure messaging: jmedina478336@direct.integrisok.com

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.

• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1801869250
  Medicare reassignment NPD
• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550
  Medicare reassignment
• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Edmond, OK
  • NPI 1124646971
  NPD
• Mercy Access LLC

  • Family Medicine Physician
  • Edmond, OK
  • NPI 1629392204
  NPD (past)
• Mercy Health Services Inc.

  • Medical Specialty Clinic/Center
  • Yukon, OK
  • NPI 1255398251
  NPD (past)
• Mercy Hospital Oklahoma City, Inc

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1184721722
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398988800000",
    "number": "1972643534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD",
            "address_2": "SUITE 140",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341785",
            "telephone_number": "405-752-3162",
            "fax_number": "405-936-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W MEMORIAL RD",
            "address_2": "ER DEPT",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208304",
            "telephone_number": "405-752-3733",
            "fax_number": "405-749-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "JOSE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2014-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200105850A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry E Medice
• Amber Grimes Medico, APRN-CNP
• Andria P Medina, MD
• Frida Axel Medina
• Jesus E Medina, MD
• Madeline Emma Medina
• Manuel J Medina
• Patrick Medina, PHARM.D.
• Medinas Therapeutic Massage LLC
• Radhika Medipalli, M.D.

• Physician Assistant in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; 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.