Bradley Martin, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Twin Falls, ID
NPI 1114536737 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1114536737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 76908 (ID)
- Practice address
- 358 Cheney Dr W Ste 101a
Twin Falls, ID 83301-6484 - Phone
- (208) 515-2273
- Fax
- (208) 515-2274
- NPI assigned
- Jul 29, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Meridian Advanced Psychiatry , LLC
Practice addresses (Care Compare)
1672 S Woodsage Ave
Suite 120
Meridian, ID 83642-7670
Phone (208) 515-2273
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230823003175 | ID | Practitioner - Nurse Practitioner | 0143683136 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76908 | ID | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meridian Advanced Psychiatry , LLC | Current |
Accepting new patients | |
| Spek Diagnostics, Inc | Current | Accepting new patients |
Locations
1672 S Woodsage Ave
Ste 120
Meridian, ID 83642
Phone (208) 515-2273
358 Cheney Dr W
Ste 101A
Twin Falls, ID 83301
Phone (208) 515-2273
Interoperability endpoints
- bradley.martin@maph.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 76908 | ID | Yes |
Addresses
Primary practice location
358 Cheney Dr W Ste 101a
Twin Falls, ID 83301-6484
Mailing address
358 Cheney Dr W Ste 101a
Twin Falls, ID 83301-6484
Phone (208) 515-2273
Other providers in Twin Falls, ID
- Megan Irene March
- Chester C Mardis
- Maria C Marez
- Marla Dawn Corporation
- Shiree Gloria Marsh
- Karen M Martinat
- Edward Justin Martinez
- Susan M Marzolf
- Steven Lee Maschek
- Bryan C. Mason
All providers in Twin Falls, ID · Psychiatric/Mental Health Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.