Active NPI
Mary Martin, MSW
- Clinical Social Worker
- Tupelo, MS
National Provider Identifier
1154743441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C-6986
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 LLC
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
| License | State | Type | Specialty |
|---|---|---|---|
| M6986 | MS | MD | Social Worker |
| C-6986 | MS | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RH Arise Venture of Tupelo LLC | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; 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.