Jesse Q. Martin, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

006066 Issued in GA

Practice address

100 Market Place Blvd
Suite 200
Cartersville, GA 30121-8718

Phone

(770) 386-7253

Fax

(770) 382-6424

NPI assigned

Mar 9, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307577600000",
    "number": "1609174093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HOSPITAL SOUTH DR",
            "address_2": "SUITE 300",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301066810",
            "telephone_number": "770-944-2830",
            "fax_number": "678-581-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARKET PLACE BLVD",
            "address_2": "SUITE 200",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301218718",
            "telephone_number": "770-386-7253",
            "fax_number": "770-382-6424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JESSE",
        "middle_name": "Q.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-09",
        "last_updated": "2011-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "006066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1609174093",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark a Fitzgerald DMD PC (Allatonna Family Dental)
• Mark Lynn OD & Associates, PC (Visionworks)
• Jenna W Markle
• Sheri C Marshall, AUD
• Cindy Lea Martin, FNP
• Ryan Lee Martin, MS
• Kimberly Lynnette Martinez, LPN
• Natalie Mathis, MA CCC-SLP
• Ramon Matos, M.D.
• Addison Lea Matter

• Medical Physician Assistant in Cartersville, GA
• Providers in Cartersville, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.