Individual provider Active NPI

Alexis Charlene Martire, CNP

  • Family Nurse Practitioner
  • Grand Rapids, MN
National Provider Identifier
1649018946
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11805 Issued in MN
Practice address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone
(218) 326-3401
Fax
(218) 999-1461
NPI assigned
Jul 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11805 MN Primary

Addresses

Primary practice location

1601 Golf Course Rd
Grand Rapids, MN 55744-8648

Mailing address

1 5TH St
Nashwauk, MN 55769-1143
Phone (218) 259-2318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240926001127 MN Practitioner - Nurse Practitioner 0042751380 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Itasca Clinic and HospitalGroup PAC ID 8123939550, 328 clinicians

Practice addresses (Care Compare)

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-3401

Hospital & facility affiliations

  • Grand Itasca Clinic and Hospital Hospital, Grand Rapids, MN, CCN 240064
  • Bigfork Valley Hospital Hospital, Bigfork, MN, CCN 241316
  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11805MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Itasca Clinic and Hospital CurrentSince Sep 1, 2024 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Sep 1, 2024 Accepting new patients

Locations

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

Interoperability endpoints

  • Direct secure messaging: amartire772604@fairview.direct-ci.com

Organizations & group practices 2

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 5

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": "1721347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1649018946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 5TH ST",
            "city": "NASHWAUK",
            "state": "MN",
            "postal_code": "557691143",
            "telephone_number": "218-259-2318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-326-3401",
            "fax_number": "218-999-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIRE",
        "first_name": "ALEXIS",
        "middle_name": "CHARLENE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-19",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "11805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.