Tabitha Danielle Martin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149022835 Issued in IL

Practice address

10509 N Manchester Dr
Peoria, IL 61615-8891

Phone

(808) 321-1792

NPI assigned

Jan 10, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tabitha.martin.p1@direct.pfh.nextgenshare.com

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.

• Occult Mental Health PLLC

  • Nurse Practitioner
  • Tremont, IL
  • NPI 1720857865

  Clinical

  NPD (past)

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

{
    "created_epoch": "1610236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610236800000",
    "number": "1053909572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10509 N MANCHESTER DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616158891",
            "telephone_number": "808-321-1792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10509 N MANCHESTER DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616158891",
            "telephone_number": "808-321-1792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TABITHA",
        "middle_name": "DANIELLE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-10",
        "last_updated": "2021-01-10",
        "certification_date": "2021-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149022835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Martin, MS, OTR/L
• Megan Reese Martin
• Robert I Martin, MD
• Samantha Martin, AGACNP-BC
• Sara Ann Martin, FNP-BC
• Derek Martinez, M.D.
• Edmundo A Martinez, M.D,
• Julio C Martinez, RN
• Kayla C Martinez, PA-C
• Mary A Marvin, ACNS BC

• Clinical Social Worker in Peoria, IL
• Providers in Peoria, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.