Carol A Martin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35705 Issued in WI

Practice address

711 W Adams St
Black River Falls, WI 54615-9108

Phone

(715) 284-5361

Fax

(715) 284-1390

NPI assigned

Jun 22, 2006

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 3

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Iowa, RJ & L Carver College of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Black River Health IncGroup PAC ID 3173431178, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Black River Memorial Hospital Hospital, Black River Falls, WI, CCN 521333

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Black River Health Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Black River Falls, WI
  • NPI 1003914011

  Corporate Director

  CMS ownership
• Black River Health Inc

  dba Black River Healthcare Clinic

  • Rural Health Clinic/Center
  • Black River Falls, WI
  • NPI 1255183182

  Corporate Director

  CMS ownership
• Black River Health Inc

  dba Krohn Clinic

  • Rural Health Clinic/Center
  • Black River Falls, WI
  • NPI 1568196764

  Corporate Director

  CMS ownership
• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331

  Corporate Director

  CMS ownership

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.

• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331
  Medicare reassignment Care Compare group NPD
• Black River Health Inc

  dba Black River Healthcare Clinic

  • Rural Health Clinic/Center
  • Black River Falls, WI
  • NPI 1255183182
  NPD

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

• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331
  Care Compare affiliation

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1326084690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159108",
            "telephone_number": "715-284-5361",
            "fax_number": "715-284-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159108",
            "telephone_number": "715-284-5361",
            "fax_number": "715-284-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CAROL",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "35705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN LICENSE NUMBER",
            "identifier": "35705",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32074500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BLUE CROSS",
            "identifier": "84D66MA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• LT Resources
• Rachel Marie Lundberg, O.D.
• Michael A Mahan, M.D.
• Making Meaning LLC
• Jesse L Mann, APSW, SAC-IT
• Amy McCarthy, OTA
• Katrina K McGillivray, DO
• Victoria Michalski
• Abigail Marie Miller, MD
• Jana Kay Millis, RN

• Family Medicine Physician in Black River Falls, WI
• Providers in Black River Falls, WI by specialty
• Family Medicine Physician in Wisconsin

• 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; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.