Individual provider Active NPI

Carlos Anibal Martins, OTRIL CHT

  • Occupational Therapist
  • Great Neck, NY
National Provider Identifier
1053400838
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
007678 Issued in NY
Practice address
107 Northern Blvd
Suite 308
Great Neck, NY 11021-4311
Phone
(516) 504-4263
Fax
(718) 281-4263
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 007678 NY Primary

Addresses

Primary practice location

107 Northern Blvd
Suite 308
Great Neck, NY 11021-4311

Mailing address

107 Northern Blvd
Suite 308
Great Neck, NY 11021-4311
Phone (516) 504-4263

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040701000150 NY Practitioner - Occupational Therapist in Private Practice 2769469469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

107 Northern Blvd
Great Neck, NY 11021-4309
Phone (516) 504-4263

11420 Rockaway Blvd
South Ozone Park, NY 11420-1912
Phone (718) 845-4616

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007678NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Queensboro Occupational Therapy P.C. Occupational Therapist CurrentSince Mar 1, 2000 Accepting new patients

Locations

107 Northern Blvd
Ste 308
Great Neck, NY 11021
Phone (516) 504-4263

11420 Rockaway Blvd
South Ozone Park, NY 11420
Phone (718) 845-4616

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

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.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1053400838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 NORTHERN BLVD",
            "address_2": "SUITE 308",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214311",
            "telephone_number": "516-504-4263",
            "fax_number": "718-281-4263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 NORTHERN BLVD",
            "address_2": "SUITE 308",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214311",
            "telephone_number": "516-504-4263",
            "fax_number": "718-281-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINS",
        "first_name": "CARLOS",
        "middle_name": "ANIBAL",
        "name_prefix": "Mr.",
        "credential": "OTRIL CHT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "007678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.