Active NPI
Martin J Lafollette, D.O.
- Family Medicine Physician
- Peoria, AZ
National Provider Identifier
1720399280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 006138
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| DO.1788 | AL | MD | Family Medicine Physician |
| 006138 | AZ | MD | Family Medicine Physician |
| CDR.0000063 | CO | MD | Family Medicine Physician |
| DO-05136 | IA | MD | Family Medicine Physician |
| OC-0010 | ID | MD | Family Medicine Physician |
| 05-40628 | KS | MD | Family Medicine Physician |
| 63228 | MN | MD | Family Medicine Physician |
| 25516 | MS | MD | Family Medicine Physician |
| MED-PHYS-LIC-61129 | MT | MD | Family Medicine Physician |
| CL0017 | NV | MD | Family Medicine Physician |
| 10776 | SD | MD | Family Medicine Physician |
| 10663123-1204 | UT | MD | Family Medicine Physician |
| 13-321 | WI | MD | Family Medicine Physician |
| 1772 | NE | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VHS Outpatient Clinics, Inc. | Past | Accepting new patients |
Interoperability endpoints
- 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.
-
- Durable Medical Equipment & Medical Supplies
- Scottsdale, AZ
- NPI 1891302790
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.