Individual provider Active NPI

Martin John, AU.D.

  • Audiologist
  • Yakima, WA
National Provider Identifier
1215988738
Registry record updated Oct 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
LD00001014 Issued in WA
Practice address
303 S 12TH Ave
Yakima, WA 98902-3112
Phone
(509) 453-8248
Fax
(509) 248-9012
NPI assigned
May 12, 2006
Last updated
Oct 11, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X LD00001014 WA Primary

Addresses

Primary practice location

303 S 12TH Ave
Yakima, WA 98902-3112

Mailing address

303 S 12TH Ave
Yakima, WA 98902-3112
Phone (509) 453-8248

Other identifiers 2

IdentifierTypeStateIssuer
9079203MedicaidWA
7098684MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090805000465 WA Practitioner - Qualified Audiologist 7810040078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tahac LLCGroup PAC ID 0749360303, 3 clinicians

Practice addresses (Care Compare)

1111 N 35TH Ave
Suite 100
Yakima, WA 98902-1622
Phone (509) 248-0933

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tahac LLC Audiologist CurrentSince Sep 26, 2016 Accepting new patients

Locations

1111 N 35th Ave
Ste 100
Yakima, WA 98902
Phone (509) 248-0933

3810 Kern Rd
Ste B
Yakima, WA 98902
Phone (509) 228-7237

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318291200000",
    "number": "1215988738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 S 12TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023112",
            "telephone_number": "509-453-8248",
            "fax_number": "509-248-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 S 12TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023112",
            "telephone_number": "509-453-8248",
            "fax_number": "509-248-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "MARTIN",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2011-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WA",
            "license": "LD00001014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9079203",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7098684",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; 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.