Elisa R. Martinez, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA12678 Issued in CA

Practice address

2101 Tenaya Dr
Modesto, CA 95354-3930

Phone

(209) 576-6766

Fax

(209) 576-6776

NPI assigned

Nov 22, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Elisa R. Kong Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Family First Medical Care a Professional Corporation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1689066029
  Medicare reassignment
• Family First Medical Care a Professional Corporation

  • Durable Medical Equipment & Medical Supplies
  • Modesto, CA
  • NPI 1699639070
  NPD

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383782400000",
    "number": "1720061716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953406805",
            "telephone_number": "209-383-1848",
            "fax_number": "209-383-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 TENAYA DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953543930",
            "telephone_number": "209-576-6766",
            "fax_number": "209-576-6776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "ELISA",
        "middle_name": "R.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2013-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA12678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISA",
            "last_name": "KONG",
            "middle_name": "R.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Deice Anay Martinez, LCSW
• Destiny Martinez
• Destiny Martinez
• Diana Guadalupe Martinez
• Diego Armando Martinez
• Gabrielle Martinez
• Genesis Esperanza Martinez
• Haaydn Martinez
• Hannah Martinez
• Isabel Cristina Martinez

• Medical Physician Assistant in Modesto, CA
• Providers in Modesto, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.