Active NPI
Jacqueline Martin
- Mental Health Counselor
- Springfield, OR
National Provider Identifier
1508313610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 180 W B St
BLDG B2
Springfield, OR 97477 - Phone
- (414) 232-6335
- Fax
- (541) 299-5685
- NPI assigned
- Sep 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | |||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
180 W B St
BLDG B2
Springfield, OR 97477
Mailing address
5411 E St
Springfield, OR 97478-6164
Phone (440) 665-5274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 24, 2026 through Mar 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Interoperability endpoints
- jacqueline.martin.p1@direct.lanecounty.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747094400000",
"number": "1508313610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5411 E ST",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974786164",
"telephone_number": "440-665-5274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 W B ST",
"address_2": "BLDG B2",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "97477",
"telephone_number": "414-232-6335",
"fax_number": "541-299-5685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JACQUELINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-07",
"last_updated": "2025-05-13",
"certification_date": "2025-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.