Individual provider Active NPI

William Martin, D.O.

  • Emergency Medicine Physician
  • Vineland, NJ
National Provider Identifier
1104937903
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MB70795 Issued in NJ
Practice address
1505 W Sherman Ave
Vineland, NJ 08360-6912
Phone
(856) 641-8000
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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 MB70795 NJ Primary

Addresses

Primary practice location

1505 W Sherman Ave
Vineland, NJ 08360-6912

Mailing address

82 Old Orchard Dr
Sicklerville, NJ 08081-3055

Other identifiers 1

IdentifierTypeStateIssuer
8214506MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20040908001514 NJ Practitioner - Emergency MedicinePractitioner - Family Practice 9234105404 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MB70795NJMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Jersey Health System Emergency Physician Services P a Emergency Medicine CurrentSince Jun 6, 2000 Accepting new patients

Locations

333 Irving Ave
Bridgeton, NJ 08302
Phone (856) 575-4500

1505 W Sherman Ave
Vineland, NJ 08360
Phone (856) 451-6600

Organizations & group practices 1

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1104937903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 OLD ORCHARD DR",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080813055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W SHERMAN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606912",
            "telephone_number": "856-641-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "WILLIAM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "MB70795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8214506",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.