Individual provider Active NPI

Kelly Ann Martinez, MD

  • Obstetrics & Gynecology Physician
  • San Marcos, CA
National Provider Identifier
1063616639
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A119682 Issued in CA
Practice address
150 Valpreda Rd
San Marcos, CA 92069-2973
Phone
(760) 736-6700
Fax
(760) 736-8740
NPI assigned
Jun 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X A119682 CA Primary

Addresses

Primary practice location

150 Valpreda Rd
San Marcos, CA 92069-2973

Mailing address

150 Valpreda Rd
San Marcos, CA 92069-2973
Phone (760) 736-6700

Other identifiers 3

IdentifierTypeStateIssuer
W14158OtherCANHC PTAN
3858222726OtherMYUTMB 3858222726-COMMERCIAL NUMBER
FW987XOtherCAIND PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120328000962 CA Practitioner - Obstetrics/GynecologyPractitioner - General Surgery 6103086186 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/GynecologyAlso: General Surgery
Education
University of Kansas School of Med (KC/Wich/Sal), 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scripps Health Inpatient Providers Medical Group IncGroup PAC ID 9436314762, 209 clinicians

Practice addresses (Care Compare)

9888 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A119682CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Obstetrics & Gynecology CurrentSince Sep 18, 2016 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 22, 2015 Accepting new patients
Regents of the University of California CurrentSince Sep 18, 2016 Accepting new patients
Scripps Health Inpatient Providers Medical Group Inc. CurrentSince Jul 1, 2024 Accepting new patients
Scripps Health Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 22, 2015 Accepting new patients
Scripps Health Current Accepting new patients

Locations

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

10666 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-2626

393 E Walnut St
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

200 W Arbor Dr
Frnt
San Diego, CA 92103

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

150 Valpreda Rd
San Marcos, CA 92069
Phone (619) 736-6700

Interoperability endpoints

  • Direct secure messaging: kmartinez61593@scrippshlth.medalliesdirect.net

Organizations & group practices 8

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1063616639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 VALPREDA RD",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692973",
            "telephone_number": "760-736-6700",
            "fax_number": "760-736-8740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 VALPREDA RD",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692973",
            "telephone_number": "760-736-6700",
            "fax_number": "760-736-8740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A119682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHC PTAN",
            "identifier": "W14158",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 3858222726-COMMERCIAL NUMBER",
            "identifier": "3858222726",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IND PTAN",
            "identifier": "FW987X",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Marcos, CA

Sources for this page

Verify at the official NPI Registry.