Individual provider Active NPI

Alexis Martinez, DPM

  • Podiatrist
  • Dixon, IL
National Provider Identifier
1619545852
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016006000 Issued in IL
Practice address
215 E 1St St Ste 310
Dixon, IL 61021-3190
Phone
(815) 285-5801
NPI assigned
Jun 14, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 016006000 IL
Student in an Organized Health Care Education/Training Program 390200000X
Podiatrist 213E00000X 016006000 IL Primary

Addresses

Primary practice location

215 E 1St St Ste 310
Dixon, IL 61021-3190

Mailing address

314 Marclare St
Dixon, IL 61021-1145
Phone (918) 533-8272

Other names 1

  • Alexis Wade Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230925002968 IL Practitioner - Podiatry 9537513536 Reassigns benefits to 2 organizations
I20240806001606 TX Practitioner - Podiatry 9537513536 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherokee NationGroup PAC ID 5799698742, 446 clinicians

Practice addresses (Care Compare)

100 S Bliss Ave
Tahlequah, OK 74464-2512
Phone (918) 458-3100

Hospital & facility affiliations

  • Cherokee Nation W W Hastings Indian Hospital Hospital, Tahlequah, OK, CCN 370171
  • Northeastern Health System Hospital, Tahlequah, OK, CCN 370089

Merit-based Incentive Payment System (MIPS)

Final score
85.4 of 100Reported as group
Quality
72.78
Promoting interoperability
98
Improvement activities
40
Cost
76.77

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
60.49
Promoting interoperability
100
Improvement activities
40
Cost
77.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue155
Removal of nail tissue19
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
394OKMDAddiction (Substance Use Disorder) Counselor
016006000ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
KSB Medical Group, Inc. CurrentSince Aug 1, 2023 Accepting new patients
Cherokee Nation CurrentSince Aug 14, 2024 Accepting new patients
Cherokee Nation CurrentSince Aug 14, 2024 Accepting new patients
Katherine Shaw Bethea Hospital CurrentSince Aug 1, 2023 Accepting new patients
Cherokee Nation Current Accepting new patients
KSB Medical Group, Inc. CurrentSince Aug 1, 2023 Accepting new patients
Cherokee Nation Current Accepting new patients
Cherokee Nation Past Accepting new patients
Cardinal Medical Group, LTD. PastSince Jun 22, 2021 Accepting new patients

Locations

215 E 1st St
Ste 310
Dixon, IL 61021
Phone (815) 285-5801

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

403 E 1st St
Dixon, IL 61021
Phone (815) 285-5629

859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271

1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201

1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192

900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500

100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100

Dept 2269
Tulsa, OK 74182

27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1619545852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MARCLARE ST",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610211145",
            "telephone_number": "918-533-8272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E 1ST ST STE 310",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213190",
            "telephone_number": "815-285-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "ALEXIS",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-14",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016006000",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016006000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "WADE",
            "credential": "DPM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dixon, IL

Sources for this page

Verify at the official NPI Registry.