Juan Carlos Martinez Grullon, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

T3999 Issued in TX

Practice address

1250 8TH Ave Ste 265
Fort Worth, TX 76104-4124

Phone

(682) 200-8580

Fax

(682) 200-8581

NPI assigned

May 28, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA, TX2 enrollments

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 2

Specialty

Plastic and Reconstructive Surgery

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Plastic Surgery Associates PAGroup PAC ID 9032361126, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmartinezgrullon918247@direct.sw.org
• Direct secure messaging: jmartinezgrullon2010592@direct.texashealth.org

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.

• Plastic Surgery Associates PA

  • Plastic and Reconstructive Surgery Physician
  • Fort Worth, TX
  • NPI 1588918551

  Plastic Surgery

  Medicare reassignment Care Compare group NPD
• St. Luke'S Physician Group, Inc.

  • Family Medicine Physician
  • Bethlehem, PA
  • NPI 1700984622
  Medicare reassignment NPD
• Plastic Surgery Associates PA

  • Plastic Surgery Physician
  • Oklahoma City, OK
  • NPI 1821568304
  NPD
• St. Luke'S Physician Group, Inc

  • Surgery Physician
  • Lehighton, PA
  • NPI 1548820350
  NPD

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1154589950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 8TH AVE",
            "address_2": "STE 265",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044124",
            "telephone_number": "682-200-8580",
            "fax_number": "682-200-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 8TH AVE STE 265",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044124",
            "telephone_number": "682-200-8580",
            "fax_number": "682-200-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ GRULLON",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-28",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "PA",
            "license": "MD448858",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "T3999",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "T3999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0182590",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tim Burt Martin
• Van Eric Martin, L.P.C.
• Wayne Martin, LCSW
• Yujin Martin, RN
• Yessica Martinez Gonzalez, RN
• Amabilia Emily Martinez, FNP-BC
• Amaris M Martinez, LPC
• Andrew E Martinez, PT
• Armando Martinez Jr., LPC
• Armando S. Martinez, MD

• Plastic and Reconstructive Surgery Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Plastic and Reconstructive Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.