Individual provider Active NPI

Martin J Lafollette, D.O.

  • Family Medicine Physician
  • Peoria, AZ
National Provider Identifier
1720399280
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
006138 Issued in AZ
Practice address
10180 W Happy Valley Rd Ste 100
Peoria, AZ 85383-1389
Phone
(623) 561-3000
Fax
(623) 561-3009
NPI assigned
Jun 29, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 10776 SD
Family Medicine Physician 207Q00000X OC-0010 ID
Family Medicine Physician 207Q00000X MED-PHYS-LIC-61129 MT
Family Medicine Physician 207Q00000X 25516 MS
Family Medicine Physician 207Q00000X OP60826527 WA
Family Medicine Physician 207Q00000X 05-40628 KS
Family Medicine Physician 207Q00000X CL0017 NV
Family Medicine Physician 207Q00000X 63228 MN
Family Medicine Physician 207Q00000X DO-05136 IA
Family Medicine Physician 207Q00000X 10663123-1204 UT
Family Medicine Physician 207Q00000X 1772 NE
Family Medicine Physician 207Q00000X DO.1788 AL
Family Medicine Physician 207Q00000X CDR.0000063 CO
Family Medicine Physician 207Q00000X 13-321 WI
Family Medicine Physician 207Q00000X 006138 AZ Primary

Addresses

Primary practice location

10180 W Happy Valley Rd Ste 100
Peoria, AZ 85383-1389

Mailing address

2303 N 390 E
Provo, UT 84604-1733
Phone (800) 997-6196

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)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO.1788ALMDFamily Medicine Physician
006138AZMDFamily Medicine Physician
CDR.0000063COMDFamily Medicine Physician
DO-05136IAMDFamily Medicine Physician
OC-0010IDMDFamily Medicine Physician
05-40628KSMDFamily Medicine Physician
63228MNMDFamily Medicine Physician
25516MSMDFamily Medicine Physician
MED-PHYS-LIC-61129MTMDFamily Medicine Physician
CL0017NVMDFamily Medicine Physician
10776SDMDFamily Medicine Physician
10663123-1204UTMDFamily Medicine Physician
13-321WIMDFamily Medicine Physician
1772NEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
VHS Outpatient Clinics, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: martin.lafollette.1@30520.direct.athenahealth.com

Organizations & group practices 1

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": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1720399280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 N 390 E",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041733",
            "telephone_number": "800-997-6196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10180 W HAPPY VALLEY RD STE 100",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853831389",
            "telephone_number": "623-561-3000",
            "fax_number": "623-561-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAFOLLETTE",
        "first_name": "MARTIN",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-29",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "10776",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "OC-0010",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-61129",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "25516",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60826527",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "05-40628",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "CL0017",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "63228",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "DO-05136",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "10663123-1204",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "1772",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO.1788",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "CDR.0000063",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "13-321",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "006138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.