NPIMap

Organization Active NPI

Doc Martins Inc a C C

Doing business as Flagstaff Family Care Clinic

  • Family Medicine Physician
  • Flagstaff, AZ
National Provider Identifier
1699724039
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32052 Issued in AZ
Legal business name
DOC MARTINS INC A C C
Doing business as
Flagstaff Family Care Clinic
Optum Primary Care
Practice address
1501 S Yale St Ste 150
Flagstaff, AZ 86001-7337
Phone
(928) 527-4325
Fax
(928) 527-4327
NPI assigned
May 10, 2006
Last updated
Jul 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Authorized official

Name
Emily Castillo
Title
Regional Manager
Phone
(702) 480-2550

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 32052 AZ Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 32051 AZ

Addresses

Primary practice location

1501 S Yale St Ste 150
Flagstaff, AZ 86001-7337

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 954-7761

Other practice location 1

2001 N 4th St
Flagstaff, AZ 86004-4227
Phone (928) 527-4325

Other names 2

  • Flagstaff Family Care Clinic Doing business as
  • Optum Primary Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040522000252 AZ Part B Supplier - Clinic/Group Practice 6608867197 Receives reassigned benefits from 10 practitioners
Practice locations: Sedona, AZ; Prescott Valley, AZ; Flagstaff, AZ; Prescott, AZ; Cottonwood, AZ

National Provider Directory

National Provider Directory

Locations

1501 S Yale St
Ste 150
Flagstaff, AZ 86001
Phone (928) 527-4325

1151 W Iron Springs Rd
Prescott, AZ 86305
Phone (928) 612-2368

Practitioners & affiliated clinicians

Practitioners 11

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": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1699724039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-954-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S YALE ST STE 150",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860017337",
            "telephone_number": "928-527-4325",
            "fax_number": "928-527-4327"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 N 4th St",
            "address_purpose": "LOCATION",
            "city": "Flagstaff",
            "state": "AZ",
            "postal_code": "860044227",
            "country_code": "US",
            "telephone_number": "928-527-4325",
            "fax_number": "928-527-4327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DOC MARTINS INC A C C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "702-480-2550"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "32052",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "32051",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Flagstaff Family Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optum Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.