Individual provider Active NPI

Stephanie Martinez, MD

  • Pediatrics Physician
  • Bronx, NY
National Provider Identifier
1710478284
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
311430 Issued in NY
Practice address
2021 Grand Concourse
Bronx, NY 10453-4317
Phone
(718) 220-2020
Fax
(718) 220-2020
NPI assigned
May 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 311430 NY Primary

Addresses

Primary practice location

2021 Grand Concourse
Bronx, NY 10453-4317

Mailing address

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451-5504
Phone (718) 579-5000

Other practice location 1

234 Eugenio Maria De Hosto Blvd
Bronx, NY 10451-5504
Phone (718) 579-5000

Other practice location 2

4422 3rd Ave
Bronx, NY 10457-2545
Phone (718) 960-9331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210826001470 NY Practitioner - Pediatric Medicine 1052716255 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
311430NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SBH Physicians, PC Pediatrics Current Accepting new patients
Union Community Health Center, Inc. CurrentSince Aug 16, 2021 Accepting new patients
SBH Physicians, PC Pediatrics CurrentSince Jun 29, 2021 Accepting new patients
Quarry Road Emergency Services P.C. Past Accepting new patients

Locations

2021 Grand Concourse
Bronx, NY 10453
Phone (718) 299-2800

4487 3rd Ave
Bronx, NY 10457
Phone (718) 960-3730

4422 3rd Ave
Bronx, NY 10457
Phone (718) 960-3917

111 E 210th St
Bronx, NY 10467

260 E 188th St
Bronx, NY 10458
Phone (718) 618-8236

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: stephanie.martinez.1@18107.direct.athenahealth.com
  • Direct secure messaging: smartinez20842@sbhny.direct-ci.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1710478284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 EUGENIO MARIA DE HOSTO BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104515504",
            "telephone_number": "718-579-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534317",
            "telephone_number": "718-220-2020",
            "fax_number": "718-220-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 Eugenio Maria De Hosto Blvd",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104515504",
            "country_code": "US",
            "telephone_number": "718-579-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4422 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104572545",
            "country_code": "US",
            "telephone_number": "718-960-9331",
            "fax_number": "718-960-3792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "STEPHANIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-21",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "311430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.