Frederick A Martin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD35685 Issued in TN

Practice address

1958 W State St
Bristol, TN 37620-1940

Phone

(423) 574-7575

Fax

(423) 574-7576

NPI assigned

Sep 20, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2012 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1164417713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1958 W STATE ST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376201940",
            "telephone_number": "423-574-7575",
            "fax_number": "423-574-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1958 W STATE ST",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376201940",
            "telephone_number": "423-574-7575",
            "fax_number": "423-574-7576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "FREDERICK",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD35685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010178835",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TN",
            "identifier": "4107515",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE #",
            "identifier": "62172092012",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3707101",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIER #",
            "identifier": "179765",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA#",
            "identifier": "4338099",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marden Medical, PLLC (Advanced Gynecology & Wellness)
• David W. Marden, DO
• Mary Kathleen Marquette, M.D.
• Amanda Rae Marshall, NP
• Nora Elizabeth Marshall, MS, CF-SLP
• Joseph Moody Martin Jr., FNP
• Phillip A Martin, CRNA
• Rachel E. Martin, ATC
• Teresa Ann Martin, MSN
• Kimberly Ann Masker, MS, OTRL

• Family Medicine Physician in Bristol, TN
• Providers in Bristol, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.