Alisia Shart Martin, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME0071972 Issued in FL

Practice address

1538 The Greens Way
Suite 101
Jacksonville Beach, FL 32250-2499

Phone

(904) 543-0161

Fax

(904) 543-9172

NPI assigned

Feb 27, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Marsh Landing Behavioral Group Inc

  • Child & Adolescent Psychiatry Physician
  • Jacksonville Beach, FL
  • NPI 1124143490
  NPD (past)
• Mental Health Center of Jacksonville, Inc.

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1366558132
  NPD (past)

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619004850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1538 THE GREENS WAY",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502499",
            "telephone_number": "904-543-0161",
            "fax_number": "904-543-9172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1538 THE GREENS WAY",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502499",
            "telephone_number": "904-543-0161",
            "fax_number": "904-543-9172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "ALISIA",
        "middle_name": "SHART",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME0071972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly S Manek, MD
• Mardi Eden Mangus, DPT
• Robert K Mannel, M.D.
• Mark a Messinese MD PA
• Marsh Landing Behavioral Group Inc
• Shakela Martin, DMD
• Sonja George Martin, MOT
• Jaime Martino, CRNP
• Mary Southwick Jones LCSW
• Joanna Matheney, RPH

• Child & Adolescent Psychiatry Physician in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.