NPIMap

Organization Active NPI

Martin McDermott MD PC

  • Family Medicine Physician
  • Fort Lupton, CO
National Provider Identifier
1205928264
Registry record updated Feb 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARTIN MCDERMOTT MD PC
Practice address
327 Park Ave
Fort Lupton, CO 80621-1929
Phone
(303) 857-2711
Fax
(303) 857-1408
NPI assigned
Sep 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2008

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

Authorized official

Name
Dr. Martin Daniel McDermott, M.D.NPI 1699784181
Title
Owner
Phone
(303) 857-2711

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

327 Park Ave
Fort Lupton, CO 80621-1929

Mailing address

327 Park Ave
Fort Lupton, CO 80621-1929
Phone (303) 857-2711

Other identifiers 1

IdentifierTypeStateIssuer
76628205MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040525001142 CO Part B Supplier - Clinic/Group Practice 5597746743 Receives reassigned benefits from 8 practitioners
Practice locations: Fort Lupton, CO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0516535Martin McDermott MD PC327 N Park Ave, Fort Lupton, CO 80621Certificate of waiverMar 3, 2028

National Provider Directory

National Provider Directory

Locations

327 Park Ave
Fort Lupton, CO 80621
Phone (303) 857-2711

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202688000000",
    "number": "1205928264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 PARK AVE",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211929",
            "telephone_number": "303-857-2711",
            "fax_number": "303-857-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 PARK AVE",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211929",
            "telephone_number": "303-857-2711",
            "fax_number": "303-857-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN MCDERMOTT MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2008-02-11",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-857-2711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76628205",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lupton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.