Individual provider Active NPI

Molly A Martin, M.D.

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1215155601
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-106034 Issued in IL
Practice address
1801 W Taylor St
Suite 2E
Chicago, IL 60612-4795
Phone
(312) 996-7414
Fax
(312) 413-8778
NPI assigned
Apr 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-106034 IL Primary

Addresses

Primary practice location

1801 W Taylor St
Suite 2E
Chicago, IL 60612-4795

Mailing address

840 S Wood St
MC 856
Chicago, IL 60612-4325
Phone (312) 996-2363

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040831000633 IL Practitioner - Pediatric Medicine 7911972245 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-106034ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Current Accepting new patients
The Board of Trustees of the University of Illinois Pediatrics CurrentSince Feb 1, 2014 Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Feb 1, 2014 Accepting new patients
Board of Trustees of the University of Illinois Pediatrics Past Accepting new patients
The Board of Trustees of the University of Illinois Past Accepting new patients

Locations

1653 W Congress Pkwy
Chicago, IL 60612
Phone (312) 942-3138

1740 W Taylor St
Ste 1400
Chicago, IL 60612
Phone (312) 996-3900

840 S Wood St
#856
Chicago, IL 60612
Phone (312) 413-1429

1801 W Taylor St
Ste 2E
Chicago, IL 60612
Phone (312) 996-7416

1801 W Taylor St
Chicago, IL 60612
Phone (312) 355-1700

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-6290

Interoperability endpoints

  • Direct secure messaging: mmartin17264@uihealth.direct-ci.com

Organizations & group practices 5

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": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413504000000",
    "number": "1215155601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "address_2": "MC 856",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "telephone_number": "312-996-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "address_2": "SUITE 2E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795",
            "telephone_number": "312-996-7414",
            "fax_number": "312-413-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MOLLY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2014-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-106034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.