Active NPI
Timothy Walter Martin
- Certified Registered Nurse Anesthetist
- Charlotte, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 176128
- Practice address
- 2001 Vail Ave
Anesthesia Department
Charlotte, NC 28207-1219 - Phone
- (704) 304-5995
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 176128 | NC | Primary |
Addresses
Primary practice location
2001 Vail Ave
Anesthesia Department
Charlotte, NC 28207-1219
Mailing address
PO Box 60499
Anesthesia Department
Charlotte, NC 28260-0499
Phone (704) 304-6202
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8052812 | Medicaid | NC | |
| NAN760 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6000
Hospital & facility affiliations
- Carolinas Medical Center/Behav Health
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CHS Anesthesia Services Group Inc | Current | Accepting new patients | |
| Mercy Hospital, Inc. | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791
2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000
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.
-
- Anesthesiology Physician
- Charlotte, NC
- NPI 1346649415
-
- Certified Registered Nurse Anesthetist
- Charlotte, NC
- NPI 1801961875
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Psychiatric Hospital Unit
- Charlotte, NC
- NPI 1053358945
-
- General Acute Care Hospital
- Charlotte, NC
- NPI 1295789907
-
- General Acute Care Hospital
- Charlotte, NC
- NPI 1376985135
-
- Children's Rehabilitation Hospital
- Charlotte, NC
- NPI 1699829887
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Charlotte, NC
- NPI 1720029705
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214784000000",
"number": "1437200219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60499",
"address_2": "ANESTHESIA DEPARTMENT",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600499",
"telephone_number": "704-304-6202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 VAIL AVE",
"address_2": "ANESTHESIA DEPARTMENT",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282071219",
"telephone_number": "704-304-5995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "TIMOTHY",
"middle_name": "WALTER",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2008-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NC",
"license": "176128",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8052812",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NAN760",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.