NPIMap

Organization Active NPI

Martin Medical Center, P.C.

  • Rural Health Clinic/Center
  • Martin, TN
National Provider Identifier
1093768988
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MARTIN MEDICAL CENTER, P.C.
Practice address
117 Kennedy Dr
Martin, TN 38237-3309
Phone
(731) 587-9511
Fax
(877) 309-6416
NPI assigned
May 19, 2006
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Mrs. Tammy M Hazlewood
Title
Administrator
Phone
(731) 587-9511

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Rural Health Clinic/Center 261QR1300X TN Primary

Addresses

Primary practice location

117 Kennedy Dr
Martin, TN 38237-3309

Mailing address

117 Kennedy Dr
Martin, TN 38237-3309
Phone (731) 587-9511

Other identifiers 2

IdentifierTypeStateIssuer
3371015MedicaidTN
2006779OtherTNBLUE CROSS BLUE SHIELD

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address martinmedicalctr@353.direct.myezyaccess.com
Other URL melissa@mmc.azalea.phimailbox.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040921001035 TN Part B Supplier - Clinic/Group Practice 9436127008 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Martin, TN
O20170817003283 TN Part A Provider - Rural Health Clinic 9436127008 Practice locations: Martin, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093768988. Details of each certification follow.

Rural health clinic certification: CCN 448990

Legal name
MARTIN MEDICAL CENTER PC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 6, 2018
Last certification
Mar 4, 2026
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Sep 23, 1970 in TN
Enrollment address
117 Kennedy Dr
Martin, TN 38237-3309

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

117 Kennedy Dr
Martin, TN 38237
Phone (731) 587-9511

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Susan S Lowry Individual 5% Or Greater Direct Ownership Interest Aug 1, 2017 33.3%
Corporate Officer Aug 1, 2017
Tammy Hazelwood Individual W-2 Managing EmployeeAdministrator Jun 1, 2017
James W Shore Individual 5% Or Greater Direct Ownership Interest Jun 1, 2017 33.3%
Corporate Officer Jun 1, 2017
Anna K Hopla Individual 5% Or Greater Direct Ownership Interest Aug 1, 2017 33.3%
Corporate Officer Aug 1, 2017

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1093768988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 KENNEDY DR",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373309",
            "telephone_number": "731-587-9511",
            "fax_number": "877-309-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 KENNEDY DR",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373309",
            "telephone_number": "731-587-9511",
            "fax_number": "877-309-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "HAZLEWOOD",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "731-587-9511",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3371015",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2006779",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "martinmedicalctr@353.direct.myezyaccess.com",
            "affiliation": "N",
            "address_1": "117 Kennedy Dr",
            "city": "Martin",
            "state": "TN",
            "country_code": "US",
            "postal_code": "382373309",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "melissa@mmc.azalea.phimailbox.com",
            "affiliation": "N",
            "address_1": "117 Kennedy Dr",
            "city": "Martin",
            "state": "TN",
            "country_code": "US",
            "postal_code": "382373394",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Martin, TN

Sources for this page

Verify at the official NPI Registry.