Edna J Martin, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

071-006181 Issued in IL

Practice address

6020 W Egidi LN
Libertyville, IL 60048-9430

Phone

(847) 362-4933

Fax

(847) 579-8516

NPI assigned

Aug 31, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Borst and Associates, IncGroup PAC ID 5597731604, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Borst & Associates Inc

  • Clinical Psychologist
  • Barrington, IL
  • NPI 1619075140
  Medicare reassignment Care Compare group NPD
• Alexian Brothers Medical Center

  • General Acute Care Hospital
  • Elk Grove Village, IL
  • NPI 1265577191
  NPD (past)
• Jeff Weishaar, Psy.D., P.C.

  • Clinical Psychologist
  • Rockford, IL
  • NPI 1538482583
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235520000000",
    "number": "1326032780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6020 W EGIDI LN",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600489430",
            "telephone_number": "847-362-4933",
            "fax_number": "847-579-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6020 W EGIDI LN",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600489430",
            "telephone_number": "847-362-4933",
            "fax_number": "847-579-8516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "EDNA",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-31",
        "last_updated": "2009-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071-006181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marsh Dermatology, SC
• Christina Ashley Marsh, M.D.
• Amy L Marshall, OT
• Martin P. Lanoff, MD., S.C.
• Colleen Ann Martin, FNP
• Stephanie Rebecca Martin, MS, RDN, LDN
• William A Martinez, MD
• Yovann Martinez
• Marvin H Heimlich,OD LLC
• Wayne W Mason, DDS

• Clinical Neuropsychologist in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Clinical Neuropsychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.