Individual provider Active NPI

Lucy Martin

  • Nurse Practitioner
  • Rockford, IL
National Provider Identifier
1285606970
Registry record updated Nov 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
041269108 Issued in IL
Practice address
3401 N Perryville Rd
Rockford, IL 61114-8011
Phone
(815) 971-2000
NPI assigned
Feb 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 041269108 IL Primary

Addresses

Primary practice location

3401 N Perryville Rd
Rockford, IL 61114-8011

Mailing address

3401 N Perryville Rd
Rockford, IL 61114-8011
Phone (815) 971-2000

Other identifiers 1

IdentifierTypeStateIssuer
L90720OtherILMEDICARE PRIOR 7/15/2007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20070823000244 IL Practitioner - Nurse Practitioner 8123110012 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041269108ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Oct 1, 2008 Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

3401 N Perryville Rd
Rockford, IL 61114

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

7180 Spring Brook Rd
Rockford, IL 61114
Phone (779) 696-2750

1235 N Mulford Rd
Ste 200
Rockford, IL 61107
Phone (815) 484-6300

Interoperability endpoints

  • Direct secure messaging: lmartin52129@direct.mhemail.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259020800000",
    "number": "1285606970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148011",
            "telephone_number": "815-971-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148011",
            "telephone_number": "815-971-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "LUCY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-06",
        "last_updated": "2009-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "041269108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PRIOR 7/15/2007",
            "identifier": "L90720",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.