Individual provider Active NPI

Michelle Martin, PAC

  • Medical Physician Assistant
  • Stanford, KY
National Provider Identifier
1003859174
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA686 Issued in KY
Practice address
100 Jay Street
Stanford, KY 40484-7511
Phone
(606) 365-1547
Fax
(606) 365-8380
NPI assigned
Jun 14, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA686 KY Primary

Addresses

Primary practice location

100 Jay Street
Stanford, KY 40484-7511

Mailing address

PO Box 330
Stanford, KY 40484-0330
Phone (606) 365-1547

Other identifiers 1

IdentifierTypeStateIssuer
9500353900MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20050216000018 KY Practitioner - Physician Assistant 0345292504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bates Miller and Sims PLLCGroup PAC ID 0840226692, 6 clinicians

Practice addresses (Care Compare)

100 Jay St
Stanford, KY 40484-7511
Phone (606) 365-1547

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Waynesburg Clinic, PLLC Past Accepting new patients

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 6

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1003859174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 330",
            "city": "STANFORD",
            "state": "KY",
            "postal_code": "404840330",
            "telephone_number": "606-365-1547",
            "fax_number": "606-365-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 JAY STREET",
            "city": "STANFORD",
            "state": "KY",
            "postal_code": "404847511",
            "telephone_number": "606-365-1547",
            "fax_number": "606-365-8380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9500353900",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, KY

Sources for this page

Verify at the official NPI Registry.