Mackenzie Kate Martin, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4113-20 Issued in MS

Practice address

68 Old Airport Rd
Hattiesburg, MS 39401-8382

Phone

(601) 583-4800

Fax

(601) 584-7769

NPI assigned

Jun 4, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmartin853809@direct.memorialcare.org

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.

• Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Hayneville, AL
  • NPI 1598788218

  AL

  Medicare reassignment NPD
• Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Montgomery, AL
  • NPI 1528082336
  NPD
• Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Montgomery, AL
  • NPI 1184284986
  NPD

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1639737646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-8700",
            "fax_number": "601-450-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 OLD AIRPORT RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018382",
            "telephone_number": "601-583-4800",
            "fax_number": "601-584-7769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-984-6028",
            "fax_number": "601-984-6039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MACKENZIE",
        "middle_name": "KATE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-04",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4113-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06359830",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Martin
• John Lloyd Martin
• Joyce Brenda Martin, CFNP
• Katherine Anne Martin, DPT
• Kayla Christine Martin, CRNA
• Olivia Martin, DPT
• Ryan James Martin, D.O.
• Tandy L Martin, CNP
• Terri M Martin, CRNA
• William Allen Martin, D.O.

• All providers in Hattiesburg, MS
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.