Individual provider Active NPI

Martin James Pearce-Vasquez, B.S.

  • Clinical Social Worker
  • Lamar, CO
National Provider Identifier
1700136363
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
CSW.09929972 Issued in CO
Practice address
100 Kendall Dr
Lamar, CO 81052-3901
Phone
(719) 336-7501
Fax
(719) 336-7453
NPI assigned
Sep 11, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Clinical Social Worker 1041C0700X CSW.09929972 CO Primary

Addresses

Primary practice location

100 Kendall Dr
Lamar, CO 81052-3901

Mailing address

711 Barnes Ave
La Junta, CO 81050-2138
Phone (719) 384-5446

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250714001101 CO Practitioner - Clinical Social Worker 1153836739 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
CSW.09929972COMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Evolve Counseling Collective LLC Clinical CurrentSince May 1, 2025 Accepting new patients

Locations

1624 Bonforte Blvd
Ste D
Pueblo, CO 81001
Phone (719) 310-5228

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750723200000",
    "number": "1700136363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 BARNES AVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502138",
            "telephone_number": "719-384-5446",
            "fax_number": "719-384-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KENDALL DR",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523901",
            "telephone_number": "719-336-7501",
            "fax_number": "719-336-7453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARCE-VASQUEZ",
        "first_name": "MARTIN",
        "middle_name": "JAMES",
        "credential": "B.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-11",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09929972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lamar, CO

Sources for this page

Verify at the official NPI Registry.