Martin Health Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R814098 Issued in MS

Legal business name

MARTIN HEALTH CARE, LLC

Practice address

218 East Main St
Florence, MS 39073-0530

Phone

(601) 845-6602

Fax

(601) 845-6164

NPI assigned

Nov 7, 2007

Last updated

Nov 7, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kelley Martin, CFNPNPI 1841384443

Title

Nurse Practitioner- President

Phone

(601) 845-6602

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669652558. Details of each certification follow.

• CCN 258953 Rural health clinic · Active · Details

Rural health clinic certification: CCN 258953

Legal name

MARTIN HEALTH CARE, LLC

Doing business as

FLORENCE FAMILY CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Nov 1, 2000

Last certification

Nov 12, 2019

Ownership / control type

1B

Most recent change of ownership

Jan 1, 2008 (2 total)

Organization structure

LLCProprietary

Enrollment address

218 East Main Street
Florence, MS 39073-0530

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Kelley N Martin, CRNP

  • Nurse Practitioner
  • Florence, MS
  • NPI 1841384443

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Practitioners 5

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.

• Kelley N Martin, CRNP

  • Nurse Practitioner
  • Florence, MS
  • NPI 1841384443
  Medicare reassignment Care Compare group NPD Authorized official
• Candice M Ashley, CFNP-BC

  • Family Nurse Practitioner
  • Florence, MS
  • NPI 1710242466
  Medicare reassignment Care Compare group NPD
• Margo Wilson Garrett, NP-C

  • Family Nurse Practitioner
  • Florence, MS
  • NPI 1285163238
  Medicare reassignment Care Compare group NPD
• James D Polk, M.D.

  • Family Medicine Physician
  • Richland, MS
  • NPI 1083601348
  Medicare reassignment NPD
• Amy M Hazlewood, NP-C

  • Family Nurse Practitioner
  • Florence, MS
  • NPI 1386921757
  NPD (past)

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1669652558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 530",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "390730530",
            "telephone_number": "601-845-6602",
            "fax_number": "601-845-6164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 EAST MAIN ST",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "390730530",
            "telephone_number": "601-845-6602",
            "fax_number": "601-845-6164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "NURSE PRACTITIONER- PRESIDENT",
        "authorized_official_telephone_number": "601-845-6602",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "R814098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald B. Little, D.C.
• M&R Personal Care Service LLC
• M360 Transit LLC
• Tracy Annette Madison
• Mari Melanie Mansir, R.PH.
• Jessica Summer Martin, DNP, CNM
• Kelley N Martin, CRNP
• Tynesha Deanna Martin
• Latonya Jaton McGowan
• Franklin Allen McKeown, ATC

• Family Medicine Physician in Florence, MS
• Providers in Florence, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.