Individual provider Active NPI

Anne F Martinez, PA

  • Physician Assistant
  • Georgetown, TX
National Provider Identifier
1205902368
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA04096 Issued in TX
Practice address
908 Rockmoor Dr
Georgetown, TX 78628-8966
Phone
(512) 868-0901
Fax
(512) 868-1527
NPI assigned
Nov 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA04096 TX Primary

Addresses

Primary practice location

908 Rockmoor Dr
Georgetown, TX 78628-8966

Mailing address

908 Rockmoor Dr
Georgetown, TX 78628-8966
Phone (512) 868-0901

Other identifiers 1

IdentifierTypeStateIssuer
PA04096OtherTXPHYSICIAN'S ASST LICENSE

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190318000056 WI Practitioner - Physician Assistant 0648249920 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2301 N Lake Dr
Milwaukee, WI 53211-4508

2311 N Prospect Ave
Milwaukee, WI 53211-4445
Phone (414) 319-3000

2323 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA04096TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Feb 15, 2019 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Feb 15, 2019 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc Past Accepting new patients

Locations

2311 N Prospect Ave
Milwaukee, WI 53211
Phone (414) 319-3000

2350 N Lake Dr
Ste 501
Milwaukee, WI 53211
Phone (414) 226-4020

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205902368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 ROCKMOOR DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288966",
            "telephone_number": "512-868-0901",
            "fax_number": "512-868-1527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 ROCKMOOR DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786288966",
            "telephone_number": "512-868-0901",
            "fax_number": "512-868-1527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "ANNE",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN'S ASST LICENSE",
            "identifier": "PA04096",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.