NPIMap

Individual provider Active NPI

Martin L. Codispoti, FNP-BC

  • Family Nurse Practitioner
  • Logan, WV
National Provider Identifier
1265717250
Registry record updated Feb 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
73900 Issued in WV
Practice address
122 Nick Savas Dr
Logan, WV 25601-3468
Phone
(304) 752-8081
Fax
(304) 752-8083
NPI assigned
Oct 21, 2011
Last updated
Feb 27, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 73900 WV Primary

Addresses

Primary practice location

122 Nick Savas Dr
Logan, WV 25601-3468

Mailing address

7400 Lynn Ave
Hamlin, WV 25523-1138
Phone (304) 824-5806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120220001166 WV Practitioner - Nurse Practitioner 3274791439 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Logan Family HealthGroup PAC ID 2567814890, 2 clinicians

Practice addresses (Care Compare)

104 Main St
Logan, WV 25601-3607
Phone (304) 752-9450

148 Enterprise Dr
Logan, WV 25601-3753
Phone (304) 752-9450

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
73900WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln County Primary Care Center, Inc Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc. CurrentSince Nov 21, 2011 Accepting new patients
Logan Family Health CurrentSince Nov 4, 2023 Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients
Lincoln County Primary Care Center, Inc Current Accepting new patients
Lincoln County Primary Care Center, Inc. Current Accepting new patients

Locations

5322 McClellan Hwy
Branchland, WV 25506
Phone (304) 824-5707

7400 Lynn Ave
Hamlin, WV 25523

104 Main St
Logan, WV 25601
Phone (304) 752-9450

122 Nick Savas Dr
Logan, WV 25601
Phone (304) 752-8081

148 Enterprise Dr
Logan, WV 25601
Phone (304) 752-4694

650 E McDonald Ave
Man, WV 25635
Phone (304) 583-8585

Organizations & group practices 9

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361923200000",
    "number": "1265717250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 LYNN AVE",
            "city": "HAMLIN",
            "state": "WV",
            "postal_code": "255231138",
            "telephone_number": "304-824-5806",
            "fax_number": "304-824-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 NICK SAVAS DR",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013468",
            "telephone_number": "304-752-8081",
            "fax_number": "304-752-8083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CODISPOTI",
        "first_name": "MARTIN",
        "middle_name": "L.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-21",
        "last_updated": "2013-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "73900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, WV

Sources for this page

Verify at the official NPI Registry.