Active NPI
Jay Martinez, ATC, LAT
- Athletic Trainer
- Surprise, AZ
National Provider Identifier
1033622980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1689
- Practice address
- 15950 N Civic Center PLZ
Surprise, AZ 85374-7464 - Phone
- (724) 766-4040
- NPI assigned
- Nov 14, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1689 | AZ | Primary |
Addresses
Primary practice location
15950 N Civic Center PLZ
Surprise, AZ 85374-7464
Mailing address
2884 E Bardonner Rd
Gibsonia, PA 15044-8222
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1689 | AZ | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529452800000",
"number": "1033622980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2884 E BARDONNER RD",
"city": "GIBSONIA",
"state": "PA",
"postal_code": "150448222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15950 N CIVIC CENTER PLZ",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853747464",
"telephone_number": "724-766-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "JAY",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-14",
"last_updated": "2018-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "1689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.