Gerald S Martin, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209015754 Issued in IL

Practice address

404 S Lewis LN
Carbondale, IL 62901-3547

Phone

(618) 519-9200

Fax

(618) 549-1288

NPI assigned

Mar 22, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shawnee Health Service and Development CorpGroup PAC ID 1658285671, 51 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gmartin6968@sih.direct-ci.com
• Direct secure messaging: gerald.martin.1@14668.direct.athenahealth.com

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.

• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carterville, IL
  • NPI 1639295314
  Medicare reassignment Care Compare group NPD
• Southern Illinois Medical Services, NFP

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment NPD
• Shawnee Health Service and Development Corp

  • Community/Retail Pharmacy
  • Carbondale, IL
  • NPI 1760253447
  NPD
• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carterville, IL
  • NPI 1811928732
  NPD
• Shawnee Health Service and Development Corp

  • Federally Qualified Health Center (FQHC)
  • Carbondale, IL
  • NPI 1285185173
  NPD (past)

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1770014748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CALIFORNIA ST",
            "address_2": "PO BOX 577",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "62918",
            "telephone_number": "618-519-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 S LEWIS LN",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013547",
            "telephone_number": "618-519-9200",
            "fax_number": "618-549-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "GERALD",
        "middle_name": "S",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-22",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209015754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "214881",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gmartin6968@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "98 Peach Ridge Rd",
            "city": "Anna",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629062243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mark L Westphal
• Vivian L Marks, NP
• Natasha Marshall
• Adrian P Martin, M.D.
• Emily L Martin, NP
• Jill Martin, NP
• Kathryn Martin
• Kevin M Martin, DO
• Kurt Martin, M.D.
• Laterriea Martin, LCSW

• Family Nurse Practitioner in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.