Individual provider Active NPI

Kelly Marie Martin, APRN

  • Family Nurse Practitioner
  • Clearwater, FL
National Provider Identifier
1033939764
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11035940 Issued in FL
Practice address
455 Pinellas St Ste 400
Clearwater, FL 33756-3356
Phone
(727) 445-1911
NPI assigned
Oct 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11035940 FL Primary

Addresses

Primary practice location

455 Pinellas St Ste 400
Clearwater, FL 33756-3356

Mailing address

577 Normandy Rd
Madeira Beach, FL 33708-2315
Phone (954) 849-0254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20250110000911 FL Practitioner - Nurse Practitioner 2062940687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

455 Pinellas St
Suite 400
Clearwater, FL 33756-3356
Phone 72744519923222

Hospital & facility affiliations

  • Mease Countryside Hospital Hospital, Safety Harbor, FL, CCN 100265
  • Morton Plant Hospital Hospital, Clearwater, FL, CCN 100127

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11035940FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clearwater Cardiovascular and Interventional Consultants MD PA CurrentSince Nov 1, 2024 Accepting new patients

Locations

455 Pinellas St
Ste 400
Clearwater, FL 33756
Phone (727) 445-1911

8839 Bryan Dairy Rd
Ste 300
Largo, FL 33777
Phone (727) 394-1911

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1033939764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "577 NORMANDY RD",
            "city": "MADEIRA BEACH",
            "state": "FL",
            "postal_code": "337082315",
            "telephone_number": "954-849-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 PINELLAS ST STE 400",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563356",
            "telephone_number": "727-445-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-16",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11035940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearwater, FL

Sources for this page

Verify at the official NPI Registry.