Active NPI
Stephen Douglas Martin, AGC, MPAS, PA-C
- Medical Physician Assistant
- Tampa, FL
National Provider Identifier
1619916202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA 9101220
- Practice address
- 1401 N Himes Ave
Tampa, FL 33607 - Phone
- (813) 393-3725
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA 9101220 | FL | Primary |
Addresses
Primary practice location
1401 N Himes Ave
Tampa, FL 33607
Mailing address
1401 N Himes Ave
Tampa, FL 33607
Phone (813) 393-3725
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9101220 | Other | FL | PA LICENSE NUMBER |
| U6812Z | Other | FL | SUPPLIER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 9101220 | FL | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277942400000",
"number": "1619916202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 N HIMES AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "33607",
"telephone_number": "813-393-3725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 N HIMES AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "33607",
"telephone_number": "813-393-3725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "STEPHEN",
"middle_name": "DOUGLAS",
"credential": "AGC, MPAS, PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2010-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA 9101220",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE NUMBER",
"identifier": "9101220",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUPPLIER ID",
"identifier": "U6812Z",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.