Active NPI
Dominic Jacob Martinez, PT, DPT
- Physical Therapist
- Dixon, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070025944
- Practice address
- 215 E 1St St
Dixon, IL 61021-3166 - Phone
- (815) 285-5591
- NPI assigned
- Jan 18, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070025944 | IL | Primary |
Addresses
Primary practice location
215 E 1St St
Dixon, IL 61021-3166
Mailing address
314 Marclare St # 314
Dixon, IL 61021-1145
Phone (505) 879-9485
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6536 | OK | MD | Dentist |
| 070025944 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherokee Nation | Current | Accepting new patients | |
| Cherokee Nation | Current | Accepting new patients | |
| Cherokee Nation | Current | Accepting new patients | |
| Cherokee Nation | Current | Accepting new patients | |
| Cherokee Nation | Past | Accepting new patients |
Locations
859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271
1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201
1020 Lenape Dr
Nowata, OK 74048
Phone (918) 273-0192
900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500
100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100
Dept 2269
Tulsa, OK 74182
27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800
Organizations & group practices 5
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.
-
- Public Health or Welfare Agency
- Tahlequah, OK
- NPI 1013884154
-
- Multi-Specialty Clinic/Center
- Muskogee, OK
- NPI 1841207156
-
- Multi-Specialty Clinic/Center
- Nowata, OK
- NPI 1891703716
-
- General Acute Care Hospital
- Tahlequah, OK
- NPI 1275799645
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1730940560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "314 MARCLARE ST # 314",
"city": "DIXON",
"state": "IL",
"postal_code": "610211145",
"telephone_number": "505-879-9485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 E 1ST ST",
"city": "DIXON",
"state": "IL",
"postal_code": "610213166",
"telephone_number": "815-285-5591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "DOMINIC",
"middle_name": "JACOB",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-18",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070025944",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dixon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.