Individual provider Active NPI

Robert P Martin, DPM

  • Foot & Ankle Surgery Podiatrist
  • Manteno, IL
National Provider Identifier
1497732499
Registry record updated Oct 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
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

Updated by the provider on Oct 27, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 SystemGroup PAC ID 3274434717, 202 clinicians

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 Hospital, Kankakee, IL, CCN 140186

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue287
Removal or shaving of skin growth12
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016004927ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Health System CurrentSince Mar 8, 2024 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.

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

Verify at the official NPI Registry.