Individual provider Active NPI

Robert Wayne Martin, M.D.

  • Cardiovascular Disease Physician
  • Silver City, NM
National Provider Identifier
1104806835
Registry record updated Sep 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD2014-0169 Issued in NM
Practice address
1290 E 32ND St
Silver City, NM 88061-7229
Phone
(575) 388-1819
Fax
(575) 388-1972
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD2014-0169 NM Primary
Cardiovascular Disease Physician 207RC0000X 20666 AZ

Addresses

Primary practice location

1290 E 32ND St
Silver City, NM 88061-7229

Mailing address

1290 E 32ND St
Silver City, NM 88061-7229
Phone (575) 388-1819

Other identifiers 2

IdentifierTypeStateIssuer
350764YKR1OtherNMMEDICARE PTAN
88659704MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161202000018 WI Practitioner - Cardiovascular Disease (Cardiology) 4284814419 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20666AZMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Wausau Hospital, Inc. CurrentSince Oct 31, 2016 Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Oct 31, 2016 Accepting new patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients
Familycare Associates,PA Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

2031 Peach St
Wisconsin Rapids, WI 54494
Phone (715) 423-0122

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410912000000",
    "number": "1104806835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 E 32ND ST",
            "city": "SILVER CITY",
            "state": "NM",
            "postal_code": "880617229",
            "telephone_number": "575-388-1819",
            "fax_number": "575-388-1972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 E 32ND ST",
            "city": "SILVER CITY",
            "state": "NM",
            "postal_code": "880617229",
            "telephone_number": "575-388-1819",
            "fax_number": "575-388-1972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "ROBERT",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2014-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NM",
            "license": "MD2014-0169",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "AZ",
            "license": "20666",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "350764YKR1",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "88659704",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver City, NM

Sources for this page

Verify at the official NPI Registry.