Individual provider Active NPI

Martha F Jay, M.D.

  • Ophthalmology Physician
  • Mequon, WI
National Provider Identifier
1003810458
Registry record updated Jan 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
32996-020 Issued in WI
Practice address
11307 N Port Washington Rd
Mequon, WI 53092-3411
Phone
(262) 241-1919
Fax
(262) 241-9046
NPI assigned
Jun 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 32996-020 WI Primary

Addresses

Primary practice location

11307 N Port Washington Rd
Mequon, WI 53092-3411

Mailing address

11307 N Port Washington Rd
Mequon, WI 53092-3411
Phone (262) 241-1919

Other identifiers 1

IdentifierTypeStateIssuer
31810400MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32996-020WIMDOphthalmology Physician

Interoperability endpoints

  • Direct secure messaging: direct@lakeshoreeyecareprofessionamequonwi.compulinkdirect.com
  • Direct secure messaging: martha.jay.1@17367.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517184000000",
    "number": "1003810458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11307 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923411",
            "telephone_number": "262-241-1919",
            "fax_number": "262-241-9046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11307 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923411",
            "telephone_number": "262-241-1919",
            "fax_number": "262-241-9046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAY",
        "first_name": "MARTHA",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-13",
        "last_updated": "2018-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": "32996-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31810400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.