Individual provider Active NPI

Martti Ellis Kahkonen, M.D.

  • Occupational Medicine Physician
  • Prescott, AZ
National Provider Identifier
1336211101
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
56015 Issued in AZ
Practice address
1050 Gail Gardner Way Ste 100
Prescott, AZ 86305-1631
Phone
(928) 777-0700
Fax
(928) 445-4464
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Physician 2083X0100X 35051440 OH
Occupational Medicine Physician 2083X0100X 56015 AZ Primary

Addresses

Primary practice location

1050 Gail Gardner Way Ste 100
Prescott, AZ 86305-1631

Mailing address

PO Box 10880
Prescott, AZ 86304-0880
Phone (602) 406-4786

Other identifiers 1

IdentifierTypeStateIssuer
56015OtherAZARIZONA MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20181025001151 AZ Practitioner - Preventive Medicine 5193897866 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35051440OHMDOccupational Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Oct 22, 2018 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Oct 22, 2018 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Upper Valley Medical Center Past Accepting new patients

Locations

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

1050 Gail Gardner Way
Ste 100
Prescott, AZ 86305
Phone (928) 443-9753

Organizations & group practices 5

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1336211101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 GAIL GARDNER WAY STE 100",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051631",
            "telephone_number": "928-777-0700",
            "fax_number": "928-445-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAHKONEN",
        "first_name": "MARTTI",
        "middle_name": "ELLIS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "OH",
            "license": "35051440",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "AZ",
            "license": "56015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA MEDICAL LICENSE",
            "identifier": "56015",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.