NPIMap

Individual provider Active NPI

Lira R Martinez, PA-C

  • Physician Assistant
  • Appleton, WI
National Provider Identifier
1609152065
Registry record updated Sep 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2850 Issued in WI
Practice address
1501 S Madison St
Appleton, WI 54915-1846
Phone
(920) 730-4443
NPI assigned
Oct 31, 2011
Last updated
Sep 15, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2012

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 2850 WI Primary

Addresses

Primary practice location

1501 S Madison St
Appleton, WI 54915-1846

Mailing address

PO Box 1047
Neenah, WI 54957-1047

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20111207000393 WI Practitioner - Physician Assistant 4183899941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ear Nose and Throat Specialists of Wisconsin SCGroup PAC ID 9830086925, 28 clinicians

Practice addresses (Care Compare)

119 E Bell St
Neenah, WI 54956-4993
Phone (920) 969-1768

444 N Westhill Blvd
Appleton, WI 54914-5715
Phone (920) 969-1768

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2850WIMDChiropractor

Organizations & group practices 1

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347667200000",
    "number": "1609152065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1047",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549571047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S MADISON ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151846",
            "telephone_number": "920-730-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "LIRA",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-31",
        "last_updated": "2012-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.