Individual provider Active NPI

Christopher Chad Martineau, PAC

  • Physician Assistant
  • Bountiful, UT
National Provider Identifier
1457478562
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6334592-1206 Issued in UT
Practice address
1551 Renaissance Towne Dr
Ste 400
Bountiful, UT 84010-7667
Phone
(801) 295-7200
Fax
(801) 295-4930
NPI assigned
Mar 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6334592-1206 UT Primary

Addresses

Primary practice location

1551 Renaissance Towne Dr
Ste 400
Bountiful, UT 84010-7667

Mailing address

1551 Renaissance Towne Dr
Ste 400
Bountiful, UT 84010-7667
Phone (801) 295-7200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211028002569 UT Practitioner - Physician Assistant 5395133045 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Orthopaedics LLCGroup PAC ID 7113282179, 26 clinicians

Practice addresses (Care Compare)

1551 Renaissance Town Dr
Suite 400
Bountiful, UT 84010-7676

Hospital & facility affiliations

  • Lakeview Hospital Hospital, Bountiful, UT, CCN 460042

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: chad.martineau.1@27251.direct.athenahealth.com

Organizations & group practices 1

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 1

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": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457478562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "STE 400",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-295-7200",
            "fax_number": "801-295-4930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 RENAISSANCE TOWNE DR",
            "address_2": "STE 400",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107667",
            "telephone_number": "801-295-7200",
            "fax_number": "801-295-4930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEAU",
        "first_name": "CHRISTOPHER",
        "middle_name": "CHAD",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6334592-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

Verify at the official NPI Registry.