NPIMap

Individual provider Active NPI

Peter Ray Martin, MD

  • Emergency Medicine Physician
  • South Bend, IN
National Provider Identifier
1104357490
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
323680 Issued in LA
Practice address
715 Park Ave
South Bend, IN 46616-1337
Phone
(574) 536-4151
NPI assigned
Mar 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 323680 LA Primary

Addresses

Primary practice location

715 Park Ave
South Bend, IN 46616-1337

Mailing address

715 Park Ave
South Bend, IN 46616-1337
Phone (574) 536-4151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20210608002538 IN Practitioner - Emergency Medicine 1557633955 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
323680LAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elite Emergency Physicians Inc Emergency Medicine CurrentSince Jul 25, 2021 Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
Cep America LLC Emergency Medicine CurrentSince May 1, 2025 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince May 1, 2025 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

600 East Blvd
Elkhart, IN 46514
Phone (574) 294-2621

200 High Park Ave
Goshen, IN 46526
Phone (219) 533-2141

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Organizations & group practices 21

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.

View all 21

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Indiana University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America LLC 995 clinicians

Practice addresses (Care Compare)

1606 N 7TH St
Terre Haute, IN 47804-2706
Phone (812) 238-7523

600 E Blvd
Elkhart, IN 46514-2483
Phone (574) 294-2621

Hospital & facility affiliations

  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
  • Goshen Hospital Hospital, Goshen, IN, CCN 150026
  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058

NPI Registry JSON

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1104357490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 PARK AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466161337",
            "telephone_number": "574-536-4151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 PARK AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466161337",
            "telephone_number": "574-536-4151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "PETER",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "323680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.