Active NPI
James Johnston Martin, M.D.
- Psychologist
- Coos Bay, OR
National Provider Identifier
1497841118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- MDO8614
- Practice address
- 2085 Thompson Road
Coos Bay, OR 97420-2085 - Phone
- (542) 269-5333
- Fax
- (541) 269-5609
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | MDO8614 | OR | Primary |
Addresses
Primary practice location
2085 Thompson Road
Coos Bay, OR 97420-2085
Mailing address
2085 Thompson Road
Coos Bay, OR 97420-2085
Phone (542) 269-5333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121632 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDO8614 | OR | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497841118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2085 THOMPSON ROAD",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202085",
"telephone_number": "542-269-5333",
"fax_number": "541-269-5609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2085 THOMPSON ROAD",
"city": "COOS BAY",
"state": "OR",
"postal_code": "974202085",
"telephone_number": "542-269-5333",
"fax_number": "541-269-5609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JAMES",
"middle_name": "JOHNSTON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "MDO8614",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121632",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Coos Bay, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.