Individual provider Active NPI

Stephen Roger Martin, M.D.

  • Ophthalmology Physician
  • Stillwater, OK
National Provider Identifier
1043247463
Registry record updated Nov 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
13792 Issued in OK
Practice address
707 S Western Rd
Stillwater, OK 74074-4126
Phone
(405) 743-4212
Fax
(405) 743-1134
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 13792 OK Primary

Addresses

Primary practice location

707 S Western Rd
Stillwater, OK 74074-4126

Mailing address

707 S Western Rd
Stillwater, OK 74074-4126
Phone (405) 743-4212

Other identifiers 1

IdentifierTypeStateIssuer
100100800AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041218000002 OK Practitioner - Ophthalmology 2961469259 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
13792OKMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Stillwater Medical Center Authority CurrentSince Jan 1, 2016 Accepting new patients
Stillwater Medical Center Authority CurrentSince Jan 1, 2016 Accepting new patients

Locations

417 Fairview Ave
Ponca City, OK 74601
Phone (580) 762-3770

707 S Western Rd
Stillwater, OK 74074
Phone (405) 743-1134

Interoperability endpoints

  • Direct secure messaging: stephen.martin.p3@direct.smc.nextgenshare.com
  • Direct secure messaging: stephen.martin.p1@direct.smc.nextgenshare.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447286400000",
    "number": "1043247463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S WESTERN RD",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744126",
            "telephone_number": "405-743-4212",
            "fax_number": "405-743-1134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 S WESTERN RD",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744126",
            "telephone_number": "405-743-4212",
            "fax_number": "405-743-1134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "STEPHEN",
        "middle_name": "ROGER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2015-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OK",
            "license": "13792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100100800A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.