NPIMap

Organization Active NPI

W Patrick Martin MD PA

  • Family Medicine Physician
  • Graham, TX
National Provider Identifier
1417066259
Registry record updated Aug 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K7815 Issued in TX
Legal business name
W PATRICK MARTIN MD PA
Practice address
1339 East St
Graham, TX 76450-4228
Phone
(940) 521-5500
Fax
(940) 521-5511
NPI assigned
Aug 29, 2006
Last updated
Aug 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2008

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

Authorized official

Name
W Patrick Martin, MD PA
Title
Owner
Phone
(940) 521-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K7815 TX Primary

Addresses

Primary practice location

1339 East St
Graham, TX 76450-4228

Mailing address

1339 East St
Graham, TX 76450-4228
Phone (940) 521-5500

Other identifiers 3

IdentifierTypeStateIssuer
0041PYOtherTXBCBS
DG3960OtherTXRAILROAD PTAN
154580801MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100422000545 TX Part B Supplier - Clinic/Group Practice 4587791538 Receives reassigned benefits from 1 practitioner
Practice locations: Graham, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217894400000",
    "number": "1417066259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1339 EAST ST",
            "city": "GRAHAM",
            "state": "TX",
            "postal_code": "764504228",
            "telephone_number": "940-521-5500",
            "fax_number": "940-521-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 EAST ST",
            "city": "GRAHAM",
            "state": "TX",
            "postal_code": "764504228",
            "telephone_number": "940-521-5500",
            "fax_number": "940-521-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W PATRICK MARTIN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2008-08-05",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "W",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "940-521-5500",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K7815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0041PY",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PTAN",
            "identifier": "DG3960",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "154580801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Graham, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.