Individual provider Active NPI

Samuel Nectali Martinez, BSW

  • Mental Health Counselor
  • Riverside, CA
National Provider Identifier
1053761155
Registry record updated Jun 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
9990 County Farm Rd
Suite 5
Riverside, CA 92503-3542
Phone
(760) 238-8385
NPI assigned
Jun 20, 2016
Last updated
Jun 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

9990 County Farm Rd
Suite 5
Riverside, CA 92503-3542

Mailing address

9990 County Farm Rd
Suite 5
Riverside, CA 92503-3542
Phone (760) 238-8385

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201216001901 CA Practitioner - Clinical Social Worker 2163834177 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1686 Barton Rd
Redlands, CA 92373-1488
Phone (909) 558-9200

28078 Baxter Rd
Suite 240242
Murrieta, CA 92563-1402
Phone (951) 290-6530

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

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

Hospital & facility affiliations 1

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": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1053761155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9990 COUNTY FARM RD",
            "address_2": "SUITE 5",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033542",
            "telephone_number": "760-238-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9990 COUNTY FARM RD",
            "address_2": "SUITE 5",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033542",
            "telephone_number": "760-238-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "SAMUEL",
        "middle_name": "NECTALI",
        "name_prefix": "Mr.",
        "credential": "BSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.