Mark W Martin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD 35980 Issued in MO

Practice address

600 NW Murray Rd
Suite 210
Lees Summit, MO 64081-1204

Phone

(816) 524-2626

Fax

(816) 524-0173

NPI assigned

Sep 20, 2005

Last updated

Dec 21, 2009By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Care at Arbor Walk, LLC

  • Family Medicine Physician
  • Lee's Summit, MO
  • NPI 1407899131
  NPD (past)
• State Line Medical Group LLC

  • Internal Medicine Physician
  • Kansas City, MO
  • NPI 1679529853
  NPD (past)

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261353600000",
    "number": "1770578361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 NW MURRAY RD",
            "address_2": "SUITE 210",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640811204",
            "telephone_number": "816-524-2626",
            "fax_number": "816-524-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NW MURRAY RD",
            "address_2": "SUITE 210",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640811204",
            "telephone_number": "816-524-2626",
            "fax_number": "816-524-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MARK",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2009-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "MD 35980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201211018",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100453490A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Martin
• Andrew Thomas Martin
• Anna Martin
• Caroline Lucille Martin, D.O.
• Haley Elizabeth Martin, MSAT, LAT, ATC
• Michelle Martin, LPC
• Sarah Martin, M.S. CCC-SLP
• Heather Marie Maruska, PHARMD
• Kristin Marx, PHARMD
• Amy Jo Masiongale, CRNA

• Family Medicine Physician in Lee's Summit, MO
• Providers in Lee's Summit, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; 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.