Active NPI
Candice Jane Martinez, PA-C
- Physician Assistant
- Richardson, TX
National Provider Identifier
1124378989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA08639
- Practice address
- 1920 N Collins Blvd
Richardson, TX 75080 - Phone
- (972) 316-4555
- NPI assigned
- Sep 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA08639 | TX | Primary |
Addresses
Primary practice location
1920 N Collins Blvd
Richardson, TX 75080
Mailing address
4471 Long Prairie Rd Ste 100
Flower Mound, TX 75028-1755
Phone (972) 316-4555
Other practice location 1
4545 Alameda Blvd NE Ste G
Albuquerque, NM 87113-1591
Phone (505) 896-2900
Other names 1
- Candice Jane Kolb
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Vein Restoration NM LLC | Past | Accepting new patients |
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.
-
- Cardiovascular Disease Physician
- Rio Rancho, NM
- NPI 1891342994
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569974400000",
"number": "1124378989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4471 LONG PRAIRIE RD STE 100",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "750281755",
"telephone_number": "972-316-4555",
"fax_number": "505-938-4198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 N COLLINS BLVD",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "75080",
"telephone_number": "972-316-4555"
}
],
"practiceLocations": [
{
"address_1": "4545 Alameda Blvd NE Ste G",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871131591",
"country_code": "US",
"telephone_number": "505-896-2900",
"fax_number": "505-938-4198",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARTINEZ",
"first_name": "CANDICE",
"middle_name": "JANE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-19",
"last_updated": "2019-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA08639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CANDICE",
"last_name": "KOLB",
"middle_name": "JANE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Richardson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.