Individual provider Active NPI

Evelyn E Martin, BS, SST

  • Social Worker
  • Detroit, MI
National Provider Identifier
1093000515
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
6803086054 Issued in MI
Practice address
2939 Russell St
Detroit, MI 48207-4825
Phone
(313) 396-5300
Fax
(313) 396-5353
NPI assigned
Jun 13, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6803086054 MI Primary

Addresses

Primary practice location

2939 Russell St
Detroit, MI 48207-4825

Mailing address

2939 Russell St
Detroit, MI 48207-4825
Phone (313) 396-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20160122000514 MI Practitioner - Clinical Social Worker 4789987926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Team Mental Health Services IncGroup PAC ID 2264451830, 33 clinicians

Practice addresses (Care Compare)

2925 Russell St
Detroit, MI 48207-4825
Phone (313) 396-5300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
6803086054MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Team Wellness Center CurrentSince Dec 16, 2015 Accepting new patients
Team Mental Health Services Inc. CurrentSince Dec 16, 2015 Accepting new patients

Locations

290 Town Center Dr
Ste 400
Dearborn, MI 48126
Phone (248) 763-5289

921 Howard St
Dearborn, MI 48124
Phone (313) 274-3700

2939 Russell St
Detroit, MI 48207
Phone (313) 369-3500

2925 Russell St
Detroit, MI 48207
Phone (313) 462-4714

Organizations & group practices 2

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": "1307923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307923200000",
    "number": "1093000515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2939 RUSSELL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074825",
            "telephone_number": "313-396-5300",
            "fax_number": "313-396-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2939 RUSSELL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074825",
            "telephone_number": "313-396-5300",
            "fax_number": "313-396-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "EVELYN",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "BS, SST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-13",
        "last_updated": "2011-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6803086054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.