Individual provider Active NPI

Timothy J Martin, MD

  • Cardiovascular Disease Physician
  • Saint Peters, MO
National Provider Identifier
1366486722
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
101609 Issued in MO
Practice address
10 Hospital Dr Ste 100
Saint Peters, MO 63376-1659
Phone
(636) 916-7272
Fax
(636) 916-7274
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 101609 MO Primary

Addresses

Primary practice location

10 Hospital Dr Ste 100
Saint Peters, MO 63376-1659

Mailing address

PO Box 959203
Saint Louis, MO 63195-2905
Phone (636) 916-7272

Other practice location 1

1050 W 10th St Ste 500
Rolla, MO 65401
Phone (573) 308-1301

Other identifiers 1

IdentifierTypeStateIssuer
010910183MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20031124000160 MO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9638073430 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Saint Louis University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

10 Hospital Dr
Suite 100
Saint Peters, MO 63376-1659
Phone (636) 916-7272

1110 Highlands Plaza Dr E
Saint Louis, MO 63110-1351
Phone (314) 273-0195

1520 Wentzville Pkwy
Wentzville, MO 63385-3408
Phone (636) 497-4000

2630 Hwy K
O Fallon, MO 63368-6624
Phone (636) 240-5454

Hospital & facility affiliations

  • Barnes-Jewish St Peters Hospital Hospital, Saint Peters, MO, CCN 260191
  • Progress West Hospital Hospital, Ofallon, MO, CCN 260219
  • Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair25

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
101609MOMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC CurrentSince Apr 10, 2025 Accepting new patients
Physician Groups LC Cardiovascular Disease CurrentSince Apr 10, 2025 Accepting new patients

Locations

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

20 Progress Point Pkwy
Ste 200
O Fallon, MO 63368
Phone (636) 916-7060

10 Hospital Dr
Ste 100
Saint Peters, MO 63376
Phone (636) 916-7272

1520 Wentzville Pkwy
Wentzville, MO 63385
Phone (636) 497-4000

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1366486722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 959203",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631952905",
            "telephone_number": "636-916-7272",
            "fax_number": "636-916-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HOSPITAL DR STE 100",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761659",
            "telephone_number": "636-916-7272",
            "fax_number": "636-916-7274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 W 10th St Ste 500",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "65401",
            "country_code": "US",
            "telephone_number": "573-308-1301",
            "fax_number": "573-202-2480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "101609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010910183",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10 Hospital Dr Ste 100",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633761659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Peters, MO

Sources for this page

Verify at the official NPI Registry.