NPIMap

Individual provider Active NPI

Thomas Lyle Martin, DO

  • Gastroenterology Physician
  • Clive, IA
National Provider Identifier
1417908922
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
3703 Issued in IA
Practice address
1378 NW 124TH St
Suite 200
Clive, IA 50325-8151
Phone
(515) 288-6097
Fax
(515) 288-6099
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 3703 IA Primary

Addresses

Primary practice location

1378 NW 124TH St
Suite 200
Clive, IA 50325-8151

Mailing address

1378 NW 124TH St
Suite 200
Clive, IA 50325-8151
Phone (515) 288-6097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060630000142 IA Practitioner - GastroenterologyPractitioner - Internal Medicine 0941212351 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iowa Digestive Disease Center PCGroup PAC ID 4183522188, 24 clinicians

Practice addresses (Care Compare)

1378 NW 124TH St
Clive, IA 50325-8151

Hospital & facility affiliations

  • Unitypoint Health - Des Moines Iowa Methodist Medi Hospital, Des Moines, IA, CCN 160082
  • Greene County Medical Center Hospital, Jefferson, IA, CCN 161325
  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy132
Upper gastrointestinal (GI) endoscopy for acid reflux145

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3703IAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greene County Medical Center Current Accepting new patients
Iowa Digestive Disease Center P.C. Gastroenterology CurrentSince Jul 24, 2006 Accepting new patients
Greene County Medical Center Gastroenterology CurrentSince May 1, 2016 Accepting new patients
Greene County Medical Center CurrentSince Jan 1, 2026 Accepting new patients
Greene County Medical Center CurrentSince May 1, 2016 Accepting new patients
Iowa Endoscopy Center, Inc. PastSince Jul 1, 2014 Accepting new patients

Locations

1378 NW 124th St
#200
Clive, IA 50325
Phone (515) 288-6097

1378 NW 124th St
Ste 200
Clive, IA 50325
Phone (515) 288-6097

1378 NW 124th St
Ste 100
Clive, IA 50325
Phone (515) 288-3342

1000 W Lincoln Way
Jefferson, IA 50129
Phone (515) 386-2114

Organizations & group practices 6

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 8

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430870400000",
    "number": "1417908922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1378 NW 124TH ST",
            "address_2": "SUITE 200",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258151",
            "telephone_number": "515-288-6097",
            "fax_number": "515-288-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1378 NW 124TH ST",
            "address_2": "SUITE 200",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503258151",
            "telephone_number": "515-288-6097",
            "fax_number": "515-288-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "THOMAS",
        "middle_name": "LYLE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2015-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IA",
            "license": "3703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clive, IA

Sources for this page

Verify at the official NPI Registry.