Susan C Martin, FNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

APN11327 Issued in TN

Practice address

1385 S Highland Ave Ste B1
Jackson, TN 38301-7547

Phone

(314) 270-4707

Fax

(731) 427-0995

NPI assigned

Oct 4, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Primary Care - South Limited

  • Primary Care Clinic/Center
  • Jackson, TN
  • NPI 1366928087
  Medicare reassignment NPD
• South Jackson Medical & Wellness Center LLC

  dba South Jackson Medical & Wellness Center

  • Primary Care Nurse Practitioner
  • Jackson, TN
  • NPI 1295570083
  NPD (past)

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1245227313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1385 S HIGHLAND AVE STE B1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383017547",
            "telephone_number": "314-270-4707",
            "fax_number": "731-427-0995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1385 S HIGHLAND AVE STE B1",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383017547",
            "telephone_number": "314-270-4707",
            "fax_number": "731-427-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "SUSAN",
        "middle_name": "C",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-04",
        "last_updated": "2023-03-07",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TN",
            "license": "APN11327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3709355",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Nicole Martin
• Janie Denise Martin, AGPCNP-BC
• Khalil Syntrel Martin
• Latesha Martin, FAM PRESERV SPEC
• Michael James Martin, D.O.
• Trent Wayne Martin, OD
• Michael Martindale, MD
• Roque C Martinez, CASE MANAGER
• Kara Mason, CRNA
• Morgan Janae Mason

• Primary Care Nurse Practitioner in Jackson, TN
• Providers in Jackson, TN by specialty
• Primary Care Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.