Individual provider Active NPI

Jeffrey Brian Martin, PA

  • Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1700837127
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102867 Issued in NC
Practice address
145 Kimel Park Dr
Suite 220
Winston Salem, NC 27103-6984
Phone
(336) 794-0057
Fax
(336) 794-0501
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 102867 NC Primary

Addresses

Primary practice location

145 Kimel Park Dr
Suite 220
Winston Salem, NC 27103-6984

Mailing address

8330 Lismore St
Clemmons, NC 27012-8854

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070620000457 NC Practitioner - Physician Assistant 0840399606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Triad Radiology Associates PLLCGroup PAC ID 8729086194, 75 clinicians

Practice addresses (Care Compare)

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-3261

830 Rockford St
Mount Airy, NC 27030-5322
Phone (336) 719-7000

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014
  • Novant Health Thomasville Medical Center Hospital, Thomasville, NC, CCN 340085

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
102867NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Neurosurgical Solutions, PA PastSince Aug 2, 2004 Accepting new patients
Orthopaedic Specialists of the Carolinas, P.a. Past Accepting new patients
Triad Radiology Associates, PLLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jmartin144772@direct.novanthealth.org

Organizations & group practices 4

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 2

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1700837127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8330 LISMORE ST",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128854",
            "fax_number": "336-794-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 KIMEL PARK DR",
            "address_2": "SUITE 220",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036984",
            "telephone_number": "336-794-0057",
            "fax_number": "336-794-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JEFFREY",
        "middle_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.