Individual provider Active NPI

Samuel A Martin IV, MSW, LCSW

  • Clinical Social Worker
  • Colorado Springs, CO
National Provider Identifier
1598176034
Registry record updated May 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW.09924848 Issued in CO
Practice address
1795 Jet Wing Dr
Colorado Springs, CO 80916-2332
Phone
(719) 572-6100
NPI assigned
May 19, 2014
Last updated
May 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CSW.09924848 CO Primary

Addresses

Primary practice location

1795 Jet Wing Dr
Colorado Springs, CO 80916-2332

Mailing address

220 Ruskin Drive
Colorado Springs, CO 80910
Phone (719) 572-6100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170921002298 CO Practitioner - Clinical Social Worker 5890069363 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Care Center LLCGroup PAC ID 5991064420, 703 clinicians

Practice addresses (Care Compare)

6566 N Marksheffel Rd
Suite 100
Colorado Springs, CO 80923-4252
Phone (719) 540-2100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Center, LLC CurrentSince Nov 1, 2021 Accepting new patients
Family Care Center, LLC CurrentSince Nov 1, 2021 Accepting new patients

Locations

2860 S Circle Dr
Ste 109
Colorado Springs, CO 80906
Phone 71954021004002

6566 N Marksheffel Rd
#100
Colorado Springs, CO 80923
Phone (719) 297-7646

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": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1598176034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RUSKIN DRIVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80910",
            "telephone_number": "719-572-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 JET WING DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809162332",
            "telephone_number": "719-572-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "SAMUEL",
        "middle_name": "A",
        "name_suffix": "IV",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-19",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09924848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.