Individual provider Active NPI

Martin Roco, FNP

  • Primary Care Nurse Practitioner
  • Napa, CA
National Provider Identifier
1255683140
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
NP95027617 Issued in CA
Practice address
1141 Pear Tree LN
Napa, CA 94558-6484
Phone
(707) 254-1770
NPI assigned
Oct 3, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 005192 CT
Family Nurse Practitioner 363LF0000X 201500803NP-PP OR
Primary Care Nurse Practitioner 363LP2300X NP95027617 CA Primary

Addresses

Primary practice location

1141 Pear Tree LN
Napa, CA 94558-6484

Mailing address

3325 Jefferson St # 1116
Napa, CA 94558-3437
Phone (562) 607-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20150608003084 OR Practitioner - Nurse Practitioner 8123254596 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
005192CTMDClinical Psychologist
NP95027617CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Icco LLC CurrentSince Jul 1, 2017 Accepting new patients
Waterfall Clinic Incorporated CurrentSince Aug 1, 2019 Accepting new patients
Icco, LLC CurrentSince Jul 1, 2017 Accepting new patients
Waterfall Clinic Incorporated Current Accepting new patients
Icco, LLC Current Accepting new patients
Waterfall Clinic, Incorporated CurrentSince Aug 1, 2019 Accepting new patients
North Bend Medical Center Inc CurrentSince Mar 1, 2020 Accepting new patients

Locations

1900 Woodland Dr
Coos Bay, OR 97420
Phone (541) 267-5151

1445 Gateway Blvd
Cottage Grove, OR 97424
Phone (541) 767-3023

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

1292 High St
Eugene, OR 97401
Phone (541) 636-3473

1890 Waite St
Ste 1
North Bend, OR 97459
Phone (541) 435-7033

Organizations & group practices 7

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": "1349222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1255683140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 JEFFERSON ST # 1116",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945583437",
            "telephone_number": "562-607-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 PEAR TREE LN",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945586484",
            "telephone_number": "707-254-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROCO",
        "first_name": "MARTIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-03",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "005192",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201500803NP-PP",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "NP95027617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Napa, CA

Sources for this page

Verify at the official NPI Registry.