NPIMap

Individual provider Active NPI

Kimberly J Martin, MD

  • Family Medicine Physician
  • Clayton, GA
National Provider Identifier
1073564480
Registry record updated Aug 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
069223 Issued in GA
Practice address
896 Highway 441 S
Clayton, GA 30525-5423
Phone
(706) 782-5991
Fax
(706) 782-5111
NPI assigned
May 12, 2006
Last updated
Aug 6, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 069223 GA Primary

Addresses

Primary practice location

896 Highway 441 S
Clayton, GA 30525-5423

Mailing address

PO Box 459
Colbert, GA 30628-0459
Phone (706) 788-3234

Other identifiers 1

IdentifierTypeStateIssuer
003129911AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20130226000406 GA Practitioner - Family Practice 5698736577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Cincinnati College of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medlink Georgia IncGroup PAC ID 3274442850, 93 clinicians

Practice addresses (Care Compare)

11 Charlie Morris Rd
Colbert, GA 30628-2445
Phone (706) 788-2127

811 Hwy 441 N
Clayton, GA 30525-4202

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
069223GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medlink Georgia Inc CurrentSince Mar 2, 2013 Accepting new patients
Medlink Georgia, Inc CurrentSince Mar 2, 2013 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Medlink Georgia Inc Past Accepting new patients

Locations

773 N Main St
Clayton, GA 30525
Phone (706) 782-0468

896 Highway 441 S
Clayton, GA 30525
Phone (706) 782-5991

17 White St
Cleveland, GA 30528
Phone (706) 865-4001

11 Charlie Morris Rd
Colbert, GA 30628
Phone (706) 738-3234

11 Charlie Morris Rd
Bldg 2
Colbert, GA 30628
Phone (706) 738-3234

396 441 Historic Hwy N
Demorest, GA 30535
Phone (706) 754-4348

Interoperability endpoints

  • Direct secure messaging: kimberly.martin.1@9864.direct.athenahealth.com
  • Direct secure messaging: kimberly.martin@mgi.eclinicaldirectplus.com

Organizations & group practices 4

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 8

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470441600000",
    "number": "1073564480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306280459",
            "telephone_number": "706-788-3234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "896 HIGHWAY 441 S",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305255423",
            "telephone_number": "706-782-5991",
            "fax_number": "706-782-5111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-12",
        "last_updated": "2016-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "069223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003129911A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, GA

Sources for this page

Verify at the official NPI Registry.