Individual provider Active NPI

Jason A. Martin

  • Family Nurse Practitioner
  • Decherd, TN
National Provider Identifier
1083173488
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
25475 Issued in TN
Practice address
2006 Decherd Blvd
Decherd, TN 37324-3818
Phone
(931) 967-7171
NPI assigned
Mar 15, 2019
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 25475 TN Primary

Addresses

Primary practice location

2006 Decherd Blvd
Decherd, TN 37324-3818

Mailing address

PO Box 1258
Waynesboro, TN 38485-1258
Phone (931) 253-1110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190429001818 TN Practitioner - Nurse Practitioner 2769724434 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amg-Southern Tennessee LLCGroup PAC ID 5991765943, 54 clinicians

Practice addresses (Care Compare)

2006 Decherd Blvd
Decherd, TN 37324-3818
Phone (931) 967-0931

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Mar 18, 2019 Accepting new patients
Amg-Southern Tennessee LLC CurrentSince Nov 1, 2020 Accepting new patients
Amg-Southern Tennessee LLC CurrentSince Nov 1, 2020 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Mar 18, 2019 Accepting new patients
Amg -Southern Tennessee LLC Past Accepting new patients

Locations

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

2006 Decherd Blvd
Decherd, TN 37324
Phone (931) 962-0561

491 Majors Blvd
Lynchburg, TN 37352
Phone (931) 759-4727

600 N Jackson St
Tullahoma, TN 37388
Phone (931) 563-5469

83 Memorial Dr
Winchester, TN 37398
Phone (931) 967-3966

Interoperability endpoints

  • Direct secure messaging: jason.martin.1@19363.direct.athenahealth.com

Organizations & group practices 5

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": "1552608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1083173488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1258",
            "city": "WAYNESBORO",
            "state": "TN",
            "postal_code": "384851258",
            "telephone_number": "931-253-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 DECHERD BLVD",
            "city": "DECHERD",
            "state": "TN",
            "postal_code": "373243818",
            "telephone_number": "931-967-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JASON",
        "middle_name": "A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-15",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "25475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decherd, TN

Sources for this page

Verify at the official NPI Registry.