Individual provider Active NPI

Andrew R Martine, M.D.

  • Diagnostic Radiology Physician
  • Saint Louis, MO
National Provider Identifier
1679573927
Registry record updated Sep 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2001021768 Issued in MO
Practice address
615 S New Ballas Rd
Dept of Radiology
Saint Louis, MO 63141-8221
Phone
(314) 251-6031
Fax
(314) 251-6343
NPI assigned
Jul 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2001021768 MO Primary

Addresses

Primary practice location

615 S New Ballas Rd
Dept of Radiology
Saint Louis, MO 63141-8221

Mailing address

11475 Olde Cabin Rd
Suite 200
Saint Louis, MO 63141-7128
Phone (314) 991-8200

Other identifiers 1

IdentifierTypeStateIssuer
207235409MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050928000257 MO Practitioner - Diagnostic Radiology 9234117623 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Arkansas College of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West County Radiological Group IncGroup PAC ID 8527966944, 105 clinicians

Practice addresses (Care Compare)

615 S New Ballas Rd
Saint Louis, MO 63141-8221
Phone (314) 251-6031

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.77 of 100Reported as group
Quality
86.95
Improvement activities
40
Cost
73.15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2001021768MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West County Radiological Group, Inc. Diagnostic Radiology CurrentSince Jul 1, 2005 Accepting new patients

Locations

1400 US Highway 61
Crystal Cty, MO 63028
Phone (636) 933-1111

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

11475 Olde Cabin Rd
Ste 200
Saint Louis, MO 63141
Phone (314) 991-8200

1000 E Cherry St
Troy, MO 63379
Phone (636) 528-3327

901 Patients First Dr
Washington, MO 63090
Phone (636) 239-7500

901 E 5th St
Washington, MO 63090
Phone (636) 239-8000

430 N Monte Vista St
Ada, OK 74820
Phone (580) 226-1251

1011 14th Ave NW
Ardmore, OK 73401
Phone (580) 220-6658

3462 Hospital Rd
Healdton, OK 73438
Phone (580) 229-0701

1000 S Byrd St
Tishomingo, OK 73460
Phone (580) 371-2327

Organizations & group practices 1

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 6

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": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252368000000",
    "number": "1679573927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11475 OLDE CABIN RD",
            "address_2": "SUITE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417128",
            "telephone_number": "314-991-8200",
            "fax_number": "314-991-8206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S NEW BALLAS RD",
            "address_2": "DEPT OF RADIOLOGY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418221",
            "telephone_number": "314-251-6031",
            "fax_number": "314-251-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINE",
        "first_name": "ANDREW",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2009-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2001021768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207235409",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.