Clinton Richard Martin, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5486 Issued in AZ

Practice address

1951 Mesquite Ave Ste F
Lake Havasu City, AZ 86403-5746

Phone

(928) 963-9333

Fax

(928) 361-2611

NPI assigned

Jul 1, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NV, AZ2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

W Milyani MD PLLCGroup PAC ID 9133502008, 6 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.83 of 100Reported as group

Quality

90.71

Improvement activities

40

Cost

51.83

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• W Milyani MD PLLC

  • MOHS-Micrographic Surgery Physician
  • Lake Havasu City, AZ
  • NPI 1104562404
  Medicare reassignment Care Compare group Authorized official
• W Milyani PC

  • Dermatology Physician
  • Mesquite, NV
  • NPI 1285509323
  Medicare reassignment NPD Authorized official
• Daniel Taheri MD PC

  • Multi-Specialty Clinic/Center
  • Las Vegas, NV
  • NPI 1407992217
  Medicare reassignment
• J H Daulat DO PC

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1194268987
  Medicare reassignment
• Thomas Dermatology

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1922279496

  AZ

  Medicare reassignment
• Douglas a. Thomas, MD

  • Dermatology Physician
  • Las Vegas, NV
  • NPI 1891897658
  NPD (past)

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

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1013228394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9101 W SAHARA AVE # 105-51",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891175772",
            "telephone_number": "702-254-1425",
            "fax_number": "702-243-5012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 MESQUITE AVE STE F",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035746",
            "telephone_number": "928-963-9333",
            "fax_number": "928-361-2611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1520 E Hammer Ln Ste 102",
            "address_purpose": "LOCATION",
            "city": "Fort Mohave",
            "state": "AZ",
            "postal_code": "864266665",
            "country_code": "US",
            "telephone_number": "928-963-9191",
            "fax_number": "928-361-2674",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "150 Tyson St",
            "address_purpose": "LOCATION",
            "city": "Quartzsite",
            "state": "AZ",
            "postal_code": "85346",
            "country_code": "US",
            "telephone_number": "928-963-9333",
            "fax_number": "928-361-2674",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 W Mohave Rd",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "AZ",
            "postal_code": "853446349",
            "country_code": "US",
            "telephone_number": "928-963-9333",
            "fax_number": "928-361-2611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CLINTON",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-01",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5486",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1351",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12064",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA0270",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013228394",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366544124",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137949",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark S Biliack MD PC
• Monica Marie Marks, M.S., ED.S.
• Madison Shea Marquez, DC
• Elizabeth L Marr, P.T., PH.D.,D.P.T.
• Anita Gail Martin, LPT
• Susan Lynn Martin, MA, LPC
• Christina Ann Martinez, OD
• Lindsay Martinez
• Steven Massad, MD
• Nancy Elizabeth Matthews, MA CCC SLP

• Physician Assistant in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.