Individual provider Active NPI

Emanuel Martinez, MD

  • Psychiatry Physician
  • Hialeah, FL
National Provider Identifier
1396231056
Registry record updated Mar 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036156897 Issued in IL
Practice address
4175 W 20TH Ave
Hialeah, FL 33012-5874
Phone
(786) 441-5332
NPI assigned
Jul 6, 2018
Last updated
Mar 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TRN26600 FL
Psychiatry Physician 2084P0800X 036156897 IL Primary

Addresses

Primary practice location

4175 W 20TH Ave
Hialeah, FL 33012-5874

Mailing address

4175 W 20TH Ave
Hialeah, FL 33012-5874
Phone (786) 441-5332

Other practice location 1

2650 Ridge Ave.
Department of Psychiatry
Evanston, IL 60201-1718
Phone (847) 570-2540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210419001453 FL Practitioner - Psychiatry 4789092487 Reassigns benefits to 1 organization
I20220325001412 IL Practitioner - Psychiatry 4789092487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Florida International Univ, College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2650 Ridge Ave
Evanston, IL 60201-1700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TRN26600FLMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Feb 28, 2022 Accepting new patients
Citrus Health Network, Inc. CurrentSince Feb 3, 2021 Accepting new patients
Endeavor Health Medical Group CurrentSince Feb 28, 2022 Accepting new patients
Citrus Health Network Inc CurrentSince Feb 3, 2021 Accepting new patients

Locations

4175 W 20th Ave
Hialeah, FL 33012
Phone (305) 424-3030

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

Organizations & group practices 4

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": "1530835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1396231056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4175 W 20TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330125874",
            "telephone_number": "786-441-5332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 W 20TH AVE",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330125874",
            "telephone_number": "786-441-5332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Ridge Ave.",
            "address_2": "Department of Psychiatry",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602011718",
            "country_code": "US",
            "telephone_number": "847-570-2540",
            "fax_number": "847-570-2939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "EMANUEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-06",
        "last_updated": "2022-03-28",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN26600",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036156897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.