NPIMap

Individual provider Active NPI

Kyle Lucas Martin, APRN, FNP-C, ENP-C

  • Family Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1558863068
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP136590 Issued in TX
Practice address
Ut Southwestern Department Emergency Medicine
5323 Harry Hines Blvd
Dallas, TX 75390-8579
Phone
(214) 648-3916
Fax
(214) 648-8423
NPI assigned
Mar 1, 2018
Last updated
Apr 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP136590 TX Primary
Registered Nurse 163W00000X 854402 TX

Addresses

Primary practice location

Ut Southwestern Department Emergency Medicine
5323 Harry Hines Blvd
Dallas, TX 75390-8579

Mailing address

206 S Weatherred Dr
Richardson, TX 75080-6021
Phone (817) 688-1769

Other practice location 1

5200 Harry Hines Blvd
Dallas, TX 75390-8579
Phone (214) 648-9235

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20180404000509 TX Practitioner - Nurse Practitioner 2961765961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5323 Harry Hines Blvd
Dallas, TX 75390-7208
Phone (216) 648-0600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
854402TXMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Apr 1, 2018 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Apr 1, 2018 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Plano Urgent Care LLC PastSince Jul 1, 2014 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Past Accepting new patients

Locations

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Interoperability endpoints

  • Direct secure messaging: kyle.martin.1@27433.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 44

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1558863068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 S WEATHERRED DR",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750806021",
            "telephone_number": "817-688-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UT SOUTHWESTERN DEPARTMENT EMERGENCY MEDICINE",
            "address_2": "5323 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753908579",
            "telephone_number": "214-648-3916",
            "fax_number": "214-648-8423"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5200 Harry Hines Blvd",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "753908579",
            "country_code": "US",
            "telephone_number": "214-648-9235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KYLE",
        "middle_name": "LUCAS",
        "credential": "APRN, FNP-C, ENP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-01",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP136590",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "854402",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.