Individual provider Active NPI

Jessica Erin Martin, PA-C

  • Physician Assistant
  • Potsdam, NY
National Provider Identifier
1477906667
Registry record updated Jul 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
23 019781 Issued in NY
Practice address
50 Leroy Street
Potsdam, NY 13676-1799
Phone
(315) 265-3300
NPI assigned
Jul 22, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2016

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 23 019781 NY Primary

Addresses

Primary practice location

50 Leroy Street
Potsdam, NY 13676-1799

Mailing address

50 Leroy Street
Potsdam, NY 13676
Phone (607) 316-3473

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20161109001701 NY Practitioner - Physician Assistant 0244519577 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

201 Market St
Suite E
Potsdam, NY 13676-1218
Phone (315) 274-9102

49 Lawrence Ave
Potsdam, NY 13676-1889
Phone (315) 261-5525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.56 of 100Reported as apm
Quality
87.76
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
019781NYMDClinical Psychologist
23 019781NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Sep 21, 2016 Accepting new patients
Massena Hospital, Inc CurrentSince Sep 1, 2021 Accepting new patients
Canton Potsdam Hospital Past Accepting new patients

Locations

80 E Main St
Canton, NY 13617
Phone (315) 261-6034

1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

49 Lawrence Ave
Potsdam, NY 13676
Phone (315) 261-5550

Organizations & group practices 5

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": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1477906667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY STREET",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "607-316-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 LEROY STREET",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761799",
            "telephone_number": "315-265-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JESSICA",
        "middle_name": "ERIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-22",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "23 019781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Potsdam, NY

Sources for this page

Verify at the official NPI Registry.