NPIMap

Individual provider Active NPI

David R Martin, M.D.

  • Nephrology Physician
  • Euless, TX
National Provider Identifier
1093774127
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
L3389 Issued in TX
Practice address
601 Westpark Way
Suite B
Euless, TX 76040-3972
Phone
(817) 283-5166
Fax
(817) 283-5176
NPI assigned
Mar 18, 2006
Last updated
Sep 23, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X L3389 TX Primary

Addresses

Primary practice location

601 Westpark Way
Suite B
Euless, TX 76040-3972

Mailing address

3801 William D Tate Ave
Ste 105
Grapevine, TX 76051-8755
Phone (817) 488-6812

Other identifiers 6

IdentifierTypeStateIssuer
207735OtherTXPACIFICARE
P000789478OtherRAILROAD MEDICARE
150569509MedicaidTX
7617368OtherTXAETNA
8CE650OtherBCBS TX
150569507MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20050630000513 TX Practitioner - NephrologyPractitioner - Internal Medicine 4789620667

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3801 William D Tate Ave
Suite 105
Grapevine, TX 76051-8755

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L3389TXMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NTKC-DFW, PLLC Nephrology Current Accepting new patients
Regional Employee Assistance Program Inc Past Accepting new patients
Renal Treatment Centers-Southeast, LP. PastSince Oct 1, 2012 Accepting new patients
Davita Nephrology Medical Associates of California Inc Nephrology Past Accepting new patients

Locations

4907 S Collins St
Ste 101
Arlington, TX 76018
Phone (817) 375-0610

2425 Highway 121
Ste 201
Bedford, TX 76021
Phone (817) 283-5166

3801 William D Tate Ave
Ste 105
Grapevine, TX 76051
Phone (817) 488-6812

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 10

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": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1093774127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 WILLIAM D TATE AVE",
            "address_2": "STE 105",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760518755",
            "telephone_number": "817-488-6812",
            "fax_number": "817-251-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 WESTPARK WAY",
            "address_2": "SUITE B",
            "city": "EULESS",
            "state": "TX",
            "postal_code": "760403972",
            "telephone_number": "817-283-5166",
            "fax_number": "817-283-5176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "L3389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFICARE",
            "identifier": "207735",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P000789478",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150569509",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7617368",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TX",
            "identifier": "8CE650",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150569507",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Euless, TX

Sources for this page

Verify at the official NPI Registry.