Individual provider Active NPI

John Blanchard Martin, PH.D

  • Clinical Psychologist
  • Flagstaff, AZ
National Provider Identifier
1083641237
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4397 Issued in AZ
Practice address
1215 N Beaver St
Flagstaff, AZ 86001-3126
Phone
(928) 773-2200
Fax
(928) 773-2300
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4397 AZ Primary

Addresses

Primary practice location

1215 N Beaver St
Flagstaff, AZ 86001-3126

Mailing address

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 213-6235

Other identifiers 2

IdentifierTypeStateIssuer
1716-057OtherWIWI LICENSE NUMBER
810762MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20130627000424 AZ Practitioner - Clinical Psychologist 4688869415 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 779-3366

1215 N Beaver St
Suite 203
Flagstaff, AZ 86001-3126
Phone (928) 773-2249

1895 N Jasper Dr
Flagstaff, AZ 86001-1632

2000 S Thompson St
Flagstaff, AZ 86001-8759
Phone (928) 226-6400

269 S Candy LN
Cottonwood, AZ 86326-4158
Phone (928) 639-6000

340 S Willard St
Cottonwood, AZ 86326-4126
Phone (928) 639-6025

7810 N US Hwy 89
Flagstaff, AZ 86004-6255
Phone (928) 522-8375

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
66.85
Promoting interoperability
99
Improvement activities
40
Cost
74.4

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4397AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Flagstaff Medical Center CurrentSince May 10, 2013 Accepting new patients
Flagstaff Pathology Associates Current Accepting new patients
Flagstaff Medical Center CurrentSince May 10, 2013 Accepting new patients
Northern Arizona Healthcare Corporation CurrentSince Nov 26, 2018 Accepting new patients
Northern Arizona Healthcare Corporation CurrentSince Nov 26, 2018 Accepting new patients
Psychiatric Services SC Clinical PastSince May 1, 1999 Accepting new patients

Locations

1298 W Finnie Flat Rd
Ste 101
Camp Verde, AZ 86322
Phone (928) 639-5555

1298 W Finnie Flat Rd
Camp Verde, AZ 86322
Phone (928) 639-5509

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

340 S Willard St
Ste 101
Cottonwood, AZ 86326
Phone (928) 639-2015

340 S Willard St
Cottonwood, AZ 86326
Phone (928) 634-5551

450 S Willard St
Ste 105
Cottonwood, AZ 86326
Phone (928) 634-1112

450 S Willard St
Cottonwood, AZ 86326
Phone (928) 649-7991

107 E Oak Ave
Ste 201
Flagstaff, AZ 86001
Phone (928) 380-5689

1050 N San Francisco St
Flagstaff, AZ 86001
Phone (928) 214-3802

1485 N Turquoise Dr
Flagstaff, AZ 86001
Phone (928) 774-6626

1215 N Beaver St
Flagstaff, AZ 86001
Phone (928) 773-2200

1200 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-6235

107 E Oak Ave
Ste 101
Flagstaff, AZ 86001
Phone (928) 774-1811

1215 N Beaver St
Ste 203
Flagstaff, AZ 86001
Phone (928) 773-2249

3700 W State Route 89A
Sedona, AZ 86336
Phone (928) 204-3000

61 Bell Rock Plz
Ste A
Sedona, AZ 86351
Phone (928) 204-4999

61 Bell Rock Plz
Sedona, AZ 86351
Phone (928) 204-4999

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1083641237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N BEAVER ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013118",
            "telephone_number": "928-213-6235",
            "fax_number": "928-213-6292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 N BEAVER ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860013126",
            "telephone_number": "928-773-2200",
            "fax_number": "928-773-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JOHN",
        "middle_name": "BLANCHARD",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "4397",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI LICENSE NUMBER",
            "identifier": "1716-057",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "810762",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.