Individual provider Active NPI

Jesse Allen Martin, MD

  • Cardiovascular Disease Physician
  • Milwaukee, WI
National Provider Identifier
1144514571
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
60909 Issued in WI
Practice address
9200 W Wisconsin Ave
Milwaukee, WI 53226
Phone
(414) 955-6777
Fax
(414) 955-6203
NPI assigned
Jun 2, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X RT-3075 NH
Cardiovascular Disease Physician 207RC0000X 60909 WI Primary

Addresses

Primary practice location

9200 W Wisconsin Ave
Milwaukee, WI 53226

Mailing address

9200 W Wisconsin Ave
Milwaukee, WI 53226-3522
Phone (414) 955-6777

Other practice location 1

16650 W Bluemound Rd Ste 200
Brookfield, WI 53005-5959
Phone (262) 827-9200

Other identifiers 1

IdentifierTypeStateIssuer
1144514571MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20150504000998 WI Practitioner - Cardiovascular Disease (Cardiology) 3375862980 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Colorado School of Medicine, Denver, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

16650 W Bluemound Rd
Suite 200
Brookfield, WI 53005-5959
Phone (262) 827-9200

21700 Intertech Dr
Brookfield, WI 53045-5197
Phone (262) 532-8300

2315 E Moreland Blvd
Waukesha, WI 53186-2939
Phone (262) 532-5700

8701 W Watertown Plank
Milwaukee, WI 53226-3548
Phone (414) 805-3666

8701 Watertown Plank Rd
Room 4041 MFRC
Milwaukee, WI 53226-3548
Phone (414) 805-3666

Hospital & facility affiliations

  • Community Memorial Hospital Hospital, Menomonee Falls, WI, CCN 520103
  • St Josephs Community Hospital West Bend Hospital, West Bend, WI, CCN 520063
  • Froedtert Memorial Lutheran Hospital Hospital, Milwaukee, WI, CCN 520177
  • Froedtert Community Hospital Hospital, New Berlin, WI, CCN 520213

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting18
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RT-3075NHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince May 19, 2018 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Jul 1, 2018 Accepting new patients
Wisconsin Health Fund CurrentSince Apr 1, 2019 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince May 19, 2018 Accepting new patients

Locations

16650 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 827-9200

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

6200 W Bluemound Rd
Milwaukee, WI 53213
Phone (414) 479-3668

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000

Interoperability endpoints

  • Direct secure messaging: jmartinmd255547@direct.froedtert.com

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534896000000",
    "number": "1144514571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263522",
            "telephone_number": "414-955-6777",
            "fax_number": "414-955-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53226",
            "telephone_number": "414-955-6777",
            "fax_number": "414-955-6203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16650 W Bluemound Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Brookfield",
            "state": "WI",
            "postal_code": "530055959",
            "country_code": "US",
            "telephone_number": "262-827-9200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JESSE",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-02",
        "last_updated": "2018-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NH",
            "license": "RT-3075",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "60909",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144514571",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.