Individual provider Active NPI

Michael Martindale, MD

  • Anesthesiology Physician
  • Jackson, TN
National Provider Identifier
1740258540
Registry record updated Jun 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD20281 Issued in TN
Practice address
616 W Forest Ave
Jackson, TN 38301-3902
Phone
(731) 422-0435
Fax
(731) 422-0478
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD20281 TN Primary

Addresses

Primary practice location

616 W Forest Ave
Jackson, TN 38301-3902

Mailing address

PO Box 400
Jackson, TN 38302-0400
Phone (731) 423-8697

Other identifiers 1

IdentifierTypeStateIssuer
3067754MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20080502000440 TN Practitioner - Anesthesiology 8628157591 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD20281TNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Center Anesthesia Inc. Anesthesiology CurrentSince Jan 1, 2021 Accepting new patients
American Anesthesiology of Tennessee, P.C. Anesthesiology CurrentSince Jan 1, 2016 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Jan 1, 2016 Accepting new patients
Jackson Clinic PA Past Accepting new patients

Locations

27 Medical Center Dr
Ste 2
Jackson, TN 38301
Phone (731) 426-0310

207 Stonebridge Blvd
Jackson, TN 38305
Phone (731) 661-6340

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

501 20th St
Ste 606
Knoxville, TN 37916
Phone (865) 331-2278

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": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403827200000",
    "number": "1740258540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383020400",
            "telephone_number": "731-423-8697",
            "fax_number": "731-422-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 W FOREST AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013902",
            "telephone_number": "731-422-0435",
            "fax_number": "731-422-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINDALE",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2014-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD20281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3067754",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.