Active NPI
Robert P Martin, DPM
- Foot & Ankle Surgery Podiatrist
- Manteno, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- Practice address
- 2825 West Division Street
Manteno, IL 60950 - Phone
- (815) 468-7117
- Fax
- (815) 468-7510
- NPI assigned
- Dec 30, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | IL | ||
| Foot & Ankle Surgery Podiatrist | 213ES0103X | IL | Primary |
Addresses
Primary practice location
2825 West Division Street
Manteno, IL 60950
Mailing address
2825 West Division Street
Manteno, IL 60950
Phone (815) 468-7117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070125000531 | IL | Practitioner - Podiatry | 1456352939 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- Kent State University College of Podiatric Medicine, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Riverside Health System
Practice addresses (Care Compare)
105 S 1St St
Willmington, IL 60481-8973
Phone (815) 476-5210
350 N Wall St 4TH Floor
Kankakee, IL 60901-2901
Phone 81593316714592
5775 E State Route 113
Coal City, IL 60416-7111
Phone (815) 634-0100
Hospital & facility affiliations
- Riverside Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 287 |
| Removal or shaving of skin growth | 12 |
| Skin biopsy | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016004927 | IL | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Health System | Current | Accepting new patients | |
| Riverside Health System | Current | Accepting new patients | |
| Gibson Community Hospital Association | Past | Accepting new patients | |
| Quality Podiatry Group, LTD | Podiatrist | Past | Accepting new patients |
Locations
300 Riverside Dr
Ste 2100
Bourbonnais, IL 60914
Phone (815) 928-9666
5775 E State Route 113
Coal City, IL 60416
Phone (815) 634-0100
1490 E Walnut St
Watseka, IL 60970
Phone (815) 432-0250
1490 E Walnut St
Ste A
Watseka, IL 60970
Phone (815) 432-7693
105 S First St
Wilmington, IL 60481
Phone (815) 476-5210
Organizations & group practices 4
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.
-
- Psychiatry Physician
- Kankakee, IL
- NPI 1336354430
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
-
- Podiatrist
- Skokie, IL
- NPI 1760585814
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": "1135900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193443200000",
"number": "1497732499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2825 WEST DIVISION STREET",
"city": "MANTENO",
"state": "IL",
"postal_code": "60950",
"telephone_number": "815-468-7117",
"fax_number": "815-468-7510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2825 WEST DIVISION STREET",
"city": "MANTENO",
"state": "IL",
"postal_code": "60950",
"telephone_number": "815-468-7117",
"fax_number": "815-468-7510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "ROBERT",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-30",
"last_updated": "2007-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "IL",
"license": null,
"primary": false
},
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Manteno, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2007; 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.
- 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.