Individual provider Active NPI

Rebecca C Martin, PA

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1518363571
Registry record updated Mar 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA09414 Issued in TX
Practice address
1307 8TH Ave Ste 506
Fort Worth, TX 76104-4142
Phone
(817) 332-6092
Fax
(817) 332-6015
NPI assigned
Nov 18, 2014
Last updated
Mar 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA09414 TX Primary

Addresses

Primary practice location

1307 8TH Ave Ste 506
Fort Worth, TX 76104-4142

Mailing address

P.O. Box 961205
Fort Worth, TX 76161-1205
Phone (817) 740-8450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150130001739 TX Practitioner - Physician Assistant 5698099257 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA09414TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Dec 22, 2014 Accepting new patients
Texas Health Physicians Group CurrentSince Dec 22, 2014 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1416268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552608000000",
    "number": "1518363571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 961205",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761611205",
            "telephone_number": "817-740-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 8TH AVE STE 506",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044142",
            "telephone_number": "817-332-6092",
            "fax_number": "817-332-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "REBECCA",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-18",
        "last_updated": "2019-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.