Individual provider Active NPI

Mary Martin, MSW

  • Clinical Social Worker
  • Tupelo, MS
National Provider Identifier
1154743441
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C-6986 Issued in MS
Practice address
2434 S Eason Blvd
Tupelo, MS 38804-6942
Phone
(662) 640-4595
Fax
(662) 680-6416
NPI assigned
Jan 6, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X M6986 MS
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X C-6986 MS Primary

Addresses

Primary practice location

2434 S Eason Blvd
Tupelo, MS 38804-6942

Mailing address

2434 S Eason Blvd
Tupelo, MS 38804-6942
Phone (662) 640-4595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250621000159 MS Practitioner - Clinical Social Worker 4880106343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
RH Arise Venture of Tupelo LLCGroup PAC ID 2567840309, 8 clinicians

Practice addresses (Care Compare)

777 Holly Hill Dr
Tupelo, MS 38801-2340
Phone (662) 432-1221

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
M6986MSMDSocial Worker
C-6986MSMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
RH Arise Venture of Tupelo LLC CurrentSince Jun 15, 2025 Accepting new patients

Locations

777 Holly Hill Dr
Tupelo, MS 38801
Phone (662) 432-1221

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.

NPI Registry JSON

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1154743441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2434 S EASON BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388046942",
            "telephone_number": "662-640-4595",
            "fax_number": "662-680-6416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2434 S EASON BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388046942",
            "telephone_number": "662-640-4595",
            "fax_number": "662-680-6416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-06",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MS",
            "license": "M6986",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C-6986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.