NPIMap

Individual provider Active NPI

Kathryn Mary Martinez, MD

  • Family Medicine Physician
  • Aberdeen, SD
National Provider Identifier
1043693849
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11116 Issued in SD
Practice address
105 S State St Ste 113
Aberdeen, SD 57401-4502
Phone
(605) 225-0378
Fax
(605) 225-7919
NPI assigned
Jun 30, 2015
Last updated
Sep 7, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2015021150 MO
Family Medicine Physician 207Q00000X 11116 SD Primary

Addresses

Primary practice location

105 S State St Ste 113
Aberdeen, SD 57401-4502

Mailing address

PO Box 1460
Aberdeen, SD 57402-1460
Phone (605) 622-2876

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181025002768 SD Practitioner - Family Practice 1355654088 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Sanford School of Medicine of University of South Dakota, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera St LukesGroup PAC ID 6406764927, 164 clinicians

Practice addresses (Care Compare)

305 S State St
Aberdeen, SD 57401-4527
Phone (605) 229-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015021150MOMDFamily Medicine Physician
11116SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St. Luke's CurrentSince Sep 10, 2018 Accepting new patients
Avera St. Lukes CurrentSince Sep 10, 2018 Accepting new patients

Locations

105 S State St
Ste 113
Aberdeen, SD 57401
Phone (605) 225-0378

305 S State St
Aberdeen, SD 57401
Phone (605) 229-3000

Interoperability endpoints

  • Direct secure messaging: kathryn.martinez@avera.sdhealthlink.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 30

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536278400000",
    "number": "1043693849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1460",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574021460",
            "telephone_number": "605-622-2876",
            "fax_number": "605-622-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S STATE ST STE 113",
            "city": "ABERDEEN",
            "state": "SD",
            "postal_code": "574014502",
            "telephone_number": "605-225-0378",
            "fax_number": "605-225-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "KATHRYN",
        "middle_name": "MARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2018-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2015021150",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "11116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, SD

Sources for this page

Verify at the official NPI Registry.