NPIMap

Individual provider Active NPI

Tammy Pruitt Martinez, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1619944154
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9110936 Issued in FL
Practice address
9130 R G Skinner Parkway
Jacksonville, FL 32256
Phone
(045) 538-0950
Fax
(904) 538-0952
NPI assigned
Mar 3, 2006
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00359 RI
Physician Assistant 363A00000X PA9110936 FL Primary

Addresses

Primary practice location

9130 R G Skinner Parkway
Jacksonville, FL 32256

Mailing address

9130 R G Skinner Parkway
Jacksonville, FL 32256
Phone (045) 538-0950

Other practice location 1

4498 Hendricks Ave
Jacksonville, FL 32207-6326
Phone (049) 854-1730

Other practice location 2

2 Wake Robin Rd
Suite 103
Lincoln, RI 02865-4241
Phone (401) 334-3105

Other identifiers 3

IdentifierTypeStateIssuer
PA00359OtherRIRI LICENSE
939025129OtherRI MEDICARE GROUP NUMBER
1619944154OtherNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20180202002155 FL Practitioner - Physician Assistant 5890735955 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
First Coast Family Medicine PAGroup PAC ID 4880791375, 5 clinicians

Practice addresses (Care Compare)

9130 RG Skinner Pkwy
Jacksonville, FL 32256-9661
Phone (904) 538-0950

Hospital & facility affiliations

  • Baptist Medical Center Beaches Hospital, Jacksonville Beach, FL, CCN 100117
  • Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Solantic of Jacksonville, LLC CurrentSince Aug 15, 2021 Accepting new patients
VMD Primary Providers of Rhode Island PC Physician Assistant PastSince Apr 3, 2023 Accepting new patients
Heathrow Internal Medicine LLC Past Accepting new patients
Memorial Hospital Past Accepting new patients
Quality Primary Care P a Past Accepting new patients

Locations

4498 Hendricks Ave
Jacksonville, FL 32207
Phone (904) 854-1730

Interoperability endpoints

  • Direct secure messaging: tammy.martinez.1@16062.direct.athenahealth.com

Organizations & group practices 8

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 3

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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1619944154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9130 R G SKINNER PARKWAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "045-538-0950",
            "fax_number": "904-538-0952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9130 R G SKINNER PARKWAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "045-538-0950",
            "fax_number": "904-538-0952"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4498 Hendricks Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322076326",
            "country_code": "US",
            "telephone_number": "049-854-1730",
            "fax_number": "904-402-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Wake Robin Rd",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "RI",
            "postal_code": "028654241",
            "country_code": "US",
            "telephone_number": "401-334-3105",
            "fax_number": "401-334-1144",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "TAMMY",
        "middle_name": "PRUITT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-03",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA00359",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI LICENSE",
            "identifier": "PA00359",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI MEDICARE GROUP NUMBER",
            "identifier": "939025129",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619944154",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.