NPIMap

Organization Active NPI

Martin Pediatric and Adolescent Clinic, PC

  • Pediatric Adolescent Medicine Physician
  • Martin, TN
National Provider Identifier
1649314501
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
MD 18562 Issued in TN
Legal business name
MARTIN PEDIATRIC AND ADOLESCENT CLINIC, PC
Practice address
142 Mount Pelia Rd
Martin, TN 38237-3812
Phone
(731) 587-9542
NPI assigned
Feb 16, 2007
Last updated
Jul 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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

Authorized official

Name
Barbara Roberts
Title
Office Manager
Phone
(731) 587-9542

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X MD 18562 TN Primary

Addresses

Primary practice location

142 Mount Pelia Rd
Martin, TN 38237-3812

Mailing address

142 Mount Pelia Rd
Martin, TN 38237-3812
Phone (731) 587-9542

Other identifiers 1

IdentifierTypeStateIssuer
3727836MedicaidTN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184112000000",
    "number": "1649314501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 MOUNT PELIA RD",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373812",
            "telephone_number": "731-587-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 MOUNT PELIA RD",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373812",
            "telephone_number": "731-587-9542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN PEDIATRIC AND ADOLESCENT CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-07-11",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "731-587-9542"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "TN",
            "license": "MD 18562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3727836",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martin, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.