Individual provider Active NPI

Rebecca Gayle Martinie, MD

  • Pediatrics Physician
  • New Berlin, WI
National Provider Identifier
1700144698
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
71893-20 Issued in WI
Practice address
4855 S Moorland Rd FL 3
New Berlin, WI 53151-7494
Phone
(262) 432-7599
Fax
(262) 432-7694
NPI assigned
Apr 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Q4630 TX
Pediatric Sports Medicine Physician 2080S0010X Q4630 TX
Pediatrics Physician 208000000X 71893-20 WI Primary

Addresses

Primary practice location

4855 S Moorland Rd FL 3
New Berlin, WI 53151-7494

Mailing address

Children'S Urgent Care
9000 W Wisconsin Avenue # Ms 958
Milwaukee, WI 53226-4874
Phone (414) 266-7615

Other identifiers 1

IdentifierTypeStateIssuer
1700144698MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
Q4630TXMDPediatrics Physician
71893-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Children'S Physician Group Pediatrics Past Accepting new patients
Children'S Health System PastSince Oct 13, 2019 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rmartinie73329@direct.chw.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1700144698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CHILDREN'S URGENT CARE",
            "address_2": "9000 W WISCONSIN AVENUE # MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 S MOORLAND RD FL 3",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517494",
            "telephone_number": "262-432-7599",
            "fax_number": "262-432-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINIE",
        "first_name": "REBECCA",
        "middle_name": "GAYLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-27",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "Q4630",
            "primary": false
        },
        {
            "code": "2080S0010X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Sports Medicine",
            "state": "TX",
            "license": "Q4630",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "71893-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700144698",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Berlin, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.