Individual provider Active NPI

Carla M. Martin, MD

  • Internal Medicine Physician
  • Providence, RI
National Provider Identifier
1376528794
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD10551 Issued in RI
Practice address
355 Prairie Ave
Providence, RI 02905-1928
Phone
(401) 444-0570
Fax
(401) 444-0427
NPI assigned
Dec 8, 2005
Last updated
Apr 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD10551 RI Primary
Pediatrics Physician 208000000X MD10551 RI

Addresses

Primary practice location

355 Prairie Ave
Providence, RI 02905-1928

Mailing address

375 Allens Ave
Providence, RI 02905-5010
Phone (401) 780-2511

Other practice location 1

407 East Ave
Suite 150
Pawtucket, RI 02860-5299
Phone (401) 616-1642

Other identifiers 1

IdentifierTypeStateIssuer
CM36051MedicaidRI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address carla.martin@providencechc.directbygreenway.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20041019000818 RI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 0648231175 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Rutgers New Jersey Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

355 Prairie Ave
Providence, RI 02905-1928
Phone (401) 444-0570

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD10551RIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Providence Community Health Centers, Inc CurrentSince Sep 12, 2016 Accepting new patients
Blackstone Valley Community Health Care, Inc. CurrentSince Jan 2, 2013 Accepting new patients
Blackstone Valley Community Health Care, Inc. CurrentSince Jan 2, 2013 Accepting new patients
The Providence Center Inc Past Accepting new patients
Memorial Hospital Internal Medicine Past Accepting new patients

Locations

1000 Broad St
Central Falls, RI 02863
Phone (401) 722-0081

9 Chestnut St
Central Falls, RI 02863
Phone (401) 722-0081

39 East Ave
Pawtucket, RI 02860
Phone (401) 722-0081

1 Randall Sq
Providence, RI 02904
Phone (401) 272-5500

1 Warren Way
Providence, RI 02905
Phone (401) 444-0400

239 Cranston St
Providence, RI 02907
Phone (401) 444-0580

31 Atwood St
Providence, RI 02909
Phone (401) 415-9000

375 Allens Ave
Providence, RI 02905
Phone (401) 444-0400

40 Candace St
Providence, RI 02908
Phone (401) 444-0550

530 N Main St
Providence, RI 02904
Phone (401) 274-2500

Interoperability endpoints

  • Direct secure messaging: carla.martin.p1@direct.bvchc.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1376528794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 ALLENS AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029055010",
            "telephone_number": "401-780-2511",
            "fax_number": "401-780-2565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 PRAIRIE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029051928",
            "telephone_number": "401-444-0570",
            "fax_number": "401-444-0427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "407 East Ave",
            "address_2": "Suite 150",
            "address_purpose": "LOCATION",
            "city": "Pawtucket",
            "state": "RI",
            "postal_code": "028605299",
            "country_code": "US",
            "telephone_number": "401-616-1642",
            "fax_number": "401-728-4437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CARLA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-08",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD10551",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "MD10551",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CM36051",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carla.martin@providencechc.directbygreenway.com",
            "affiliation": "N",
            "address_1": "355 Prairie Ave",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029051928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.