Corey Martin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2024011272 Issued in MO

Practice address

11330 Olive Blvd Ste 150
Creve Coeur, MO 63141-7149

Phone

(314) 336-2566

NPI assigned

Apr 9, 2024

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

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Physician Assistant

Education

Mississippi Medical College, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ortho Missouri LLCGroup PAC ID 8527417229, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Ortho Missouri, LLC

  • Orthopaedic Surgery Physician
  • Creve Coeur, MO
  • NPI 1447941067
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1023861192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11330 OLIVE BLVD STE 150",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417149",
            "telephone_number": "314-766-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11330 OLIVE BLVD STE 150",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417149",
            "telephone_number": "314-336-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "COREY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2024011272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Markun, DPT
• Marlon G Mangahas MD LLC
• Thao Tran Marquez, MD,MS
• Tammy Anne Martielli, PH.D.
• Alayna Martin, SLP
• Nicole Michelle Martinez, M.D.
• Krysta Shaye Maskey, FNP
• Sara Emma Massie
• Abigail Mather, MS, NCC, LPC
• Allen E Mathieu, PAC,ATC,MS

• Physician Assistant in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.