NPIMap

Individual provider Active NPI

Demetrio Jose Prota Martinez, M.D.

  • Psychiatry Physician
  • Tupelo, MS
National Provider Identifier
1508206558
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
24914 Issued in MS
Practice address
830 S Gloster St
Tupelo, MS 38801
Phone
(662) 377-7590
NPI assigned
Jul 4, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 24914 MS Primary

Addresses

Primary practice location

830 S Gloster St
Tupelo, MS 38801

Mailing address

830 S Gloster St
Tupelo, MS 38801-4934
Phone (662) 377-7590

Other practice location 1

234 E 149th St
Bronx, NY 10451-5504
Phone (718) 579-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170805000217 MS Practitioner - Psychiatry 6901177146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
North Mississippi Medical Center, Inc. 361 clinicians

Practice addresses (Care Compare)

4579 S Eason Blvd
Suite a
Tupelo, MS 38801-6539
Phone (662) 377-6161

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
24914MSMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center CurrentSince Jul 13, 2017 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medcial Center, Inc. CurrentSince Jul 13, 2017 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients

Locations

4579 S Eason Blvd
Ste A
Tupelo, MS 38801
Phone (662) 377-6161

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

4579 S Eason Blvd
Ste Ef
Tupelo, MS 38801
Phone (662) 377-7590

4579 S Eason Blvd
Tupelo, MS 38801
Phone (662) 377-3161

Interoperability endpoints

  • Direct secure messaging: demetrioprotamartinez@nmhs.medalliesdirect.net

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1372896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1508206558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 S GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014934",
            "telephone_number": "662-377-7590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S GLOSTER ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38801",
            "telephone_number": "662-377-7590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 E 149th St",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104515504",
            "country_code": "US",
            "telephone_number": "718-579-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROTA MARTINEZ",
        "first_name": "DEMETRIO",
        "middle_name": "JOSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-04",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "24914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.