Individual provider Active NPI

Juan Martinez, MD

  • MOHS-Micrographic Surgery Physician
  • Jacksonville, FL
National Provider Identifier
1700926896
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
ME101583 Issued in FL
Practice address
1639 Atlantic Blvd Ste 100
Jacksonville, FL 32207-3346
Phone
(664) 003-3768
Fax
(904) 354-0376
NPI assigned
Feb 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X ME101583 FL Primary
Dermatology Physician 207N00000X ME101583 FL
MOHS-Micrographic Surgery Physician 207ND0101X 101583 FL

Addresses

Primary practice location

1639 Atlantic Blvd Ste 100
Jacksonville, FL 32207-3346

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (866) 400-3376

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081121000564 FL Practitioner - Micrographic Dermatologic Surgery (MDS)Practitioner - Dermatology 5799881843 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Micrographic Dermatologic Surgery (MDS)
Education
Mayo Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1639 Atlantic Blvd
Suite 100
Jacksonville, FL 32207-3346
Phone (904) 354-4488

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision36
Removal of skin lesions1-10
Removal of skin cancer1259
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy33

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME101583FLMDDermatology Physician
101583FLMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Leavitt Medical Associates of Florida Inc Dermatology CurrentSince May 1, 2021 Accepting new patients
Leavitt Medical Associates of Florida Inc Dermatology CurrentSince May 1, 2021 Accepting new patients

Locations

1639 Atlantic Blvd
Ste 100
Jacksonville, FL 32207

12525 Philips Hwy
Ste 101
Jacksonville, FL 32256
Phone (904) 400-6565

151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293

1893 Kingsley Ave
Ste B
Orange Park, FL 32073
Phone (904) 272-6955

1410 W Broadway St
Ste 205
Oviedo, FL 32765
Phone (407) 359-2100

520 US Highway A1A N
Ste 203
Ponte Vedra Beach, FL 32082
Phone (904) 273-6200

200 Southpark Blvd
Ste 207
St Augustine, FL 32086
Phone (904) 810-2377

1503 Buenos Aires Blvd
Ste 100
The Villages, FL 32159
Phone (352) 753-2812

Interoperability endpoints

  • Direct secure messaging: juan.martinez@adcs1.emadirect.md

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": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1700926896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "866-400-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 ATLANTIC BLVD STE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322073346",
            "telephone_number": "664-003-3768",
            "fax_number": "904-354-0376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "JUAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-07",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME101583",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME101583",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "101583",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.