NPIMap

Individual provider Active NPI

Charles K Martin, PA

  • Physician Assistant
  • Wausau, WI
National Provider Identifier
1114101813
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3241-23 Issued in WI
Practice address
225000 Hummingbird Rd Ste 100
Wausau, WI 54401-2950
Phone
(715) 359-6442
NPI assigned
Dec 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3241-23 WI Primary
Physician Assistant 363A00000X 10000978A IN

Addresses

Primary practice location

225000 Hummingbird Rd Ste 100
Wausau, WI 54401-2950

Mailing address

225000 Hummingbird Rd Ste 100
Wausau, WI 54401-2950
Phone (715) 359-6442

Other practice location 1

5050 N Clinton St
Fort Wayne, IN 46825-5822
Phone (260) 484-8551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20131204000442 WI Practitioner - Physician Assistant 5193801413 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bone and Joint Clinic S.C.Group PAC ID 3678541919, 45 clinicians

Practice addresses (Care Compare)

100 S Eagle Dr
Merrill, WI 54452-3716
Phone (715) 536-7181

1767 Park Ave
Suite 100
Plover, WI 54467-4301
Phone (800) 445-6442

225000 Hummingbird Rd
Suite 100
Wausau, WI 54401-2950
Phone (715) 359-6442

400 Westwood Dr
Suite 100
Wausau, WI 54401-7801
Phone (800) 445-6442

724 S 8TH St
Medford, WI 54451-2001
Phone (715) 748-2663

Hospital & facility affiliations

  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030
  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019
  • Aspirus Tomahawk Hospital Hospital, Tomahawk, WI, CCN 521313
  • Aspirus Medford Hospital & Clinics, Inc Hospital, Medford, WI, CCN 521324
  • Howard Young Medical Center Hospital, Woodruff, WI, CCN 520091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1859MNMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Bone & Joint Clinic S.C. CurrentSince Dec 2, 2013 Accepting new patients
Bone & Joint Clinic S.C. CurrentSince Dec 2, 2013 Accepting new patients
Primary Specialists Past Accepting new patients
Redimed Dekalb LLC Past Accepting new patients

Locations

724 S 8th St
Medford, WI 54451
Phone (715) 748-2663

1767 Park Ave
#100
Plover, WI 54467
Phone (715) 344-1260

225000 Hummingbird Rd
Ste 100
Rib Mountain, WI 54401
Phone 71535964421615

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.

Hospital & facility affiliations 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1114101813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225000 HUMMINGBIRD RD STE 100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012950",
            "telephone_number": "715-359-6442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225000 HUMMINGBIRD RD STE 100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544012950",
            "telephone_number": "715-359-6442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5050 N Clinton St",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468255822",
            "country_code": "US",
            "telephone_number": "260-484-8551",
            "fax_number": "260-484-9603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CHARLES",
        "middle_name": "K",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-18",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3241-23",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000978A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.