NPIMap

Individual provider Active NPI

Terry A Martin, CRNA

  • Certified Registered Nurse Anesthetist
  • Dodge City, KS
National Provider Identifier
1639178874
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
54522 Issued in KS
Practice address
100 W Ross Blvd
Dodge City, KS 67801-7216
Phone
(620) 225-2847
Fax
(620) 225-7046
NPI assigned
Jul 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 54522 KS Primary

Addresses

Primary practice location

100 W Ross Blvd
Dodge City, KS 67801-7216

Mailing address

915 N 5TH St
Cimarron, KS 67835-9262
Phone (620) 855-7208

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200521000896 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 1658315585 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etas PLLCGroup PAC ID 8123481934, 43 clinicians

Practice addresses (Care Compare)

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
54522KSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Etas, PLLC CurrentSince Aug 1, 2023 Accepting new patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2022 Accepting new patients
Hogan Surgical Center PA CurrentSince Feb 1, 2024 Accepting new patients
Pain Consultants of Alabama, LLC Past Accepting new patients
Anesthesia Critical Care Nursing,PA Past Accepting new patients
Minneola District Hospital NBR 2 Past Accepting new patients

Locations

7956 Vaughn Rd
Ste 165
Montgomery, AL 36116

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

4500 13th St
Fl 2
Gulfport, MS 39501
Phone (228) 865-3281

351 Cowan Rd
Gulfport, MS 39507
Phone (228) 896-1120

4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451

1926 23rd Ave
Meridian, MS 39301
Phone (601) 485-1131

3882 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 872-6290

Organizations & group practices 6

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 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1639178874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N 5TH ST",
            "city": "CIMARRON",
            "state": "KS",
            "postal_code": "678359262",
            "telephone_number": "620-855-7208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W ROSS BLVD",
            "city": "DODGE CITY",
            "state": "KS",
            "postal_code": "678017216",
            "telephone_number": "620-225-2847",
            "fax_number": "620-225-7046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TERRY",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "54522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dodge City, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.