Individual provider Active NPI

Robert M Martin, PA-C

  • Otolaryngology Physician
  • Albuquerque, NM
National Provider Identifier
1548385339
Registry record updated Aug 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
PA2002-0009 Issued in NM
Practice address
201 Cedar SE Suite 4640
PMG Cedar ENT
Albuquerque, NM 87106
Phone
(505) 563-6450
Fax
(505) 563-6484
NPI assigned
Mar 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X PA2002-0009 NM Primary

Addresses

Primary practice location

201 Cedar SE Suite 4640
PMG Cedar ENT
Albuquerque, NM 87106

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5356

Other identifiers 1

IdentifierTypeStateIssuer
62325353MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20100105000764 NM Practitioner - Physician Assistant 3678614138 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince May 26, 2016 Accepting new patients
Presbyterian Healthcare Services CurrentSince May 26, 2016 Accepting new patients

Locations

201 Cedar St SE
Ste 4640
Albuquerque, NM 87106
Phone (505) 563-6450

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218758400000",
    "number": "1548385339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-5356",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 CEDAR SE SUITE 4640",
            "address_2": "PMG CEDAR ENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87106",
            "telephone_number": "505-563-6450",
            "fax_number": "505-563-6484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "ROBERT",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NM",
            "license": "PA2002-0009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62325353",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.