Active NPI
Jeffrey Edward Martin, CRNA
- Certified Registered Nurse Anesthetist
- Palatka, FL
National Provider Identifier
1639180409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- APRN9223834
- Practice address
- 611 Zeagler Dr
Palatka, FL 32177-3810 - Phone
- (386) 328-5711
- NPI assigned
- Aug 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R0084629 | OK | |
| Certified Registered Nurse Anesthetist | 367500000X | APRN9223834 | FL | Primary |
Addresses
Primary practice location
611 Zeagler Dr
Palatka, FL 32177-3810
Mailing address
RR 1 Box 475
Idabel, OK 74745-9766
Phone (580) 245-1182
Other practice location 1
1301 Lincoln Rd
Idabel, OK 74745-7300
Phone (580) 286-7623
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5Y758 | Other | AR | BC/BS AR |
| 200075140A | Medicaid | OK |
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
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN9223834 | FL | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1639180409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 1 BOX 475",
"city": "IDABEL",
"state": "OK",
"postal_code": "747459766",
"telephone_number": "580-245-1182",
"fax_number": "580-208-3199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 ZEAGLER DR",
"city": "PALATKA",
"state": "FL",
"postal_code": "321773810",
"telephone_number": "386-328-5711"
}
],
"practiceLocations": [
{
"address_1": "1301 Lincoln Rd",
"address_purpose": "LOCATION",
"city": "Idabel",
"state": "OK",
"postal_code": "747457300",
"country_code": "US",
"telephone_number": "580-286-7623",
"fax_number": "580-208-3199",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARTIN",
"first_name": "JEFFREY",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "OK",
"license": "R0084629",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "FL",
"license": "APRN9223834",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS AR",
"identifier": "5Y758",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200075140A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palatka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.