NPIMap

Individual provider Active NPI

Timothy Martindale, MD

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1003824632
Registry record updated May 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K2959 Issued in TX
Practice address
7104 New Sanger Rd
Waco, TX 76712-3928
Phone
(254) 741-1113
Fax
(254) 741-1342
NPI assigned
Aug 3, 2006
Last updated
May 6, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K2959 TX Primary

Addresses

Primary practice location

7104 New Sanger Rd
Waco, TX 76712-3928

Mailing address

PO Box 20308
Waco, TX 76702-0308
Phone (254) 741-1113

Other identifiers 5

IdentifierTypeStateIssuer
092314601MedicaidTX
8A6564OtherTXBLUE CROSS AND BLUE SHIEL
080181687OtherTXMEDICARE RAILROAD
00N59XOtherTXBLUE CROSS BLUE SHIELD
040481601MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080625000145 TX Practitioner - Family Practice 5294806808 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical Branch at Galveston, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians
Martindale Family Medicine Clinic PAGroup PAC ID 3870846066, 2 clinicians

Practice addresses (Care Compare)

5400 Laurel Lake Dr
Waco, TX 76710-2835
Phone (254) 399-6633

7104 New Sanger Ave
Waco, TX 76712-3928
Phone (254) 262-3188

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions15
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Martindale Family Medicine Clinic PA Family Medicine CurrentSince Sep 4, 2018 Accepting new patients

Locations

7104 Sanger Rd
Woodway, TX 76712
Phone (254) 262-3188

Interoperability endpoints

  • Direct secure messaging: admin@providence.e-mdsdirect.com
  • FHIR API: https://api.platform.athenahealth.com/18441/brand/1/csg/1/fhir/r4
  • Direct secure messaging: timothy.martindale.1@18441.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367798400000",
    "number": "1003824632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20308",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767020308",
            "telephone_number": "254-741-1113",
            "fax_number": "254-741-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7104 NEW SANGER RD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123928",
            "telephone_number": "254-741-1113",
            "fax_number": "254-741-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINDALE",
        "first_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2013-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K2959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092314601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "8A6564",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080181687",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00N59X",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040481601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.