Geronimo Marten-Ellis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2930T Issued in TX

Practice address

620-C Ft.Hood.Rd.
Killeen, TX 76541

Phone

(254) 200-1010

Fax

(254) 213-9315

NPI assigned

Oct 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Temple Optometrists, P.C.

  • Optometrist
  • Temple, TX
  • NPI 1932283710
  Medicare reassignment NPD
• Consolidated Opticals of Texas, Inc.

  • Eyewear Supplier
  • Copperas Cove, TX
  • NPI 1962588004
  NPD (past)

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264550400000",
    "number": "1467538322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2020",
            "city": "HARKER HEIGHTS",
            "state": "TX",
            "postal_code": "765480020",
            "telephone_number": "254-200-1010",
            "fax_number": "254-213-9315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620-C FT.HOOD.RD.",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "76541",
            "telephone_number": "254-200-1010",
            "fax_number": "254-213-9315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTEN-ELLIS",
        "first_name": "GERONIMO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2010-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2930T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD TX",
            "identifier": "00E83Z",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPERIOR HEALTH PLAN",
            "identifier": "19823",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCOTT&WHITE",
            "identifier": "286426",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ITPE",
            "identifier": "751861475",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019810301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAFEGUARD",
            "identifier": "55635",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PRIME",
            "identifier": "751861475",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE VISION/EYEMED",
            "identifier": "930417",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTCARE",
            "identifier": "128218100",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Makaila Marsh, PA-C
• Rebecca Jean Marsh, PSYD
• Spencer Miles Marsh
• William Stevens Marsh III, DO
• Gerard L Marten-Ellis, M.D.
• Valerie Elise Marten-Ellis, O.D.
• Brianna Martin
• Craig Martin, DMD
• Jason R Martin, PA-C
• Katherine Megan Martin, LCSW

• Optometrist in Killeen, TX
• Providers in Killeen, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.