Individual provider Active NPI

Mary K Martin, CRNA

  • Certified Registered Nurse Anesthetist
  • Flint, MI
National Provider Identifier
1235102815
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704102089 Issued in MI
Practice address
401 S Ballenger Hwy
Attn Surgical Services
Flint, MI 48532-3638
Phone
(810) 342-4917
Fax
(810) 342-1335
NPI assigned
Feb 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704102089 MI Primary

Addresses

Primary practice location

401 S Ballenger Hwy
Attn Surgical Services
Flint, MI 48532-3638

Mailing address

401 S Ballenger Hwy
Attn Surgical Services
Flint, MI 48532-3638
Phone (810) 342-4917

Other identifiers 2

IdentifierTypeStateIssuer
MM102089OtherMIBLUE SHIELD
2738014MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Flint Nurse Anesthetist, Certified Registered Past Accepting new patients
American Anesthesiology Associates of Michigan, PC Nurse Anesthetist, Certified Registered Past Accepting new patients

Organizations & group practices 2

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": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1235102815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "address_2": "ATTN SURGICAL SERVICES",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-4917",
            "fax_number": "810-342-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S BALLENGER HWY",
            "address_2": "ATTN SURGICAL SERVICES",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323638",
            "telephone_number": "810-342-4917",
            "fax_number": "810-342-1335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704102089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "MM102089",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2738014",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.