Active NPI
Martin Surgical Associates LLC
- Surgery Physician
- Dayton, OH
National Provider Identifier
1104897008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- MARTIN SURGICAL ASSOCIATES LLC
- Practice address
- 8940 Kingsridge Drive
Suite 105
Dayton, OH 45458 - Phone
- (937) 439-4178
- Fax
- (937) 439-4740
- NPI assigned
- Jan 30, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Derrick J Martin Sr., MD
- Title
- President
- Phone
- (937) 439-4178
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary |
Addresses
Primary practice location
8940 Kingsridge Drive
Suite 105
Dayton, OH 45458
Mailing address
8940 Kingsridge Drive
Suite 105
Dayton, OH 45458
Phone (937) 439-4178
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D60556 | Other | OH | CHOICECARE |
| 000000189411 | Other | OH | ANTHEM |
| 0803330 | Medicaid | OH |
National Provider Directory
National Provider DirectoryLocations
8940 Kingsridge Dr
Ste 105
Dayton, OH 45458
Phone (937) 439-4178
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physician Assistant
- Miamisburg, OH
- NPI 1639203441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1196121600000",
"number": "1104897008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8940 KINGSRIDGE DRIVE",
"address_2": "SUITE 105",
"city": "DAYTON",
"state": "OH",
"postal_code": "45458",
"telephone_number": "937-439-4178",
"fax_number": "937-439-4740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8940 KINGSRIDGE DRIVE",
"address_2": "SUITE 105",
"city": "DAYTON",
"state": "OH",
"postal_code": "45458",
"telephone_number": "937-439-4178",
"fax_number": "937-439-4740"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARTIN SURGICAL ASSOCIATES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-30",
"last_updated": "2007-11-27",
"status": "A",
"authorized_official_last_name": "MARTIN",
"authorized_official_first_name": "DERRICK",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "937-439-4178",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Sr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHOICECARE",
"identifier": "D60556",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000189411",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0803330",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.