Individual provider Active NPI

Dustin Scott Martin, PA-C

  • Physician Assistant
  • Fort Sill, OK
National Provider Identifier
1215033469
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
4301 Moway Rd
Reynolds Army Community Hospital (Attn: Ruby Prescott)
Fort Sill, OK 73503-6300
Phone
(580) 458-2134
Fax
(580) 458-2314
NPI assigned
Sep 15, 2006
Sex
Male
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 Primary

Addresses

Primary practice location

4301 Moway Rd
Reynolds Army Community Hospital (Attn: Ruby Prescott)
Fort Sill, OK 73503-6300

Mailing address

515 LN Lauman
Fort Sill, OK 73503-5000
Phone (580) 250-1740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20221203000160 OK Order and Referring Only - Physician Assistant 5496124034

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hospital Authority Past Accepting new patients

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215033469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 LN LAUMAN",
            "city": "FORT SILL",
            "state": "OK",
            "postal_code": "735035000",
            "telephone_number": "580-250-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 MOWAY RD",
            "address_2": "REYNOLDS ARMY COMMUNITY HOSPITAL (ATTN: RUBY PRESCOTT)",
            "city": "FORT SILL",
            "state": "OK",
            "postal_code": "735036300",
            "telephone_number": "580-458-2134",
            "fax_number": "580-458-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DUSTIN",
        "middle_name": "SCOTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Sill, OK

Sources for this page

Verify at the official NPI Registry.