Individual provider Active NPI

Laura Susan Martin, MD

  • Clinical Genetics (M.D.) Physician
  • Tallahassee, FL
National Provider Identifier
1356381834
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X
License
ME43734 Issued in FL
Practice address
3333 Capital Oaks Dr
Tallahassee, FL 32308-4513
Phone
(850) 431-4041
Fax
(850) 431-4471
NPI assigned
Jun 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Genetics (M.D.) Physician 207SG0201X ME43734 FL Primary
Urology Physician 208800000X ME43734 FL

Addresses

Primary practice location

3333 Capital Oaks Dr
Tallahassee, FL 32308-4513

Mailing address

3333 Capital Oaks Dr
Tallahassee, FL 32308-4513
Phone (850) 431-7021

Other identifiers 3

IdentifierTypeStateIssuer
278957400MedicaidFL
102212446AMedicaidGA
102212446AOtherGAMEDICAID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20070904000474 FL Practitioner - Pediatric Medicine 1456312271 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME43734FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tallahassee Memorial Healthcare Inc Current Accepting new patients
Tallahassee Memorial Healthcare Inc CurrentSince Mar 1, 2017 Accepting new patients
Tallahassee Memorial Healthcare Inc CurrentSince Mar 1, 2017 Accepting new patients

Locations

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

1609 Physicians Dr
Tallahassee, FL 32308
Phone (850) 431-4243

3333 Capital Oaks Dr
Tallahassee, FL 32308
Phone (850) 431-4470

1309 Thomasville Rd
Tallahassee, FL 32303
Phone (850) 431-5910

Organizations & group practices 3

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1356381834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 CAPITAL OAKS DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084513",
            "telephone_number": "850-431-7021",
            "fax_number": "850-431-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 CAPITAL OAKS DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084513",
            "telephone_number": "850-431-4041",
            "fax_number": "850-431-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "LAURA",
        "middle_name": "SUSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "FL",
            "license": "ME43734",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME43734",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278957400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102212446A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "102212446A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.