Individual provider Active NPI

Susan G Martin, FNP-C

  • Family Nurse Practitioner
  • Buffalo, NY
National Provider Identifier
1770663734
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP081535 Issued in ME
Practice address
155 Lawn Ave
Buffalo, NY 14207-1816
Phone
(716) 875-2904
NPI assigned
Oct 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP081535 ME Primary

Addresses

Primary practice location

155 Lawn Ave
Buffalo, NY 14207-1816

Mailing address

155 Lawn Ave
Buffalo, NY 14207-1816
Phone (716) 875-2904

Other identifiers 1

IdentifierTypeStateIssuer
432097699MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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

Enrollment IDStateProvider typePAC IDDetails
I20050110000941 ME Practitioner - Nurse Practitioner 3173571700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Recover Together IncGroup PAC ID 7810247533, 141 clinicians

Practice addresses (Care Compare)

77 Park St
Rockland, ME 04841-2846
Phone (800) 683-8313

849 Stillwater Ave
Bangor, ME 04401-3624
Phone (800) 683-8313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP081535MEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Recover Together, LLC Family CurrentSince Apr 1, 2022 Accepting new patients
Recover Together, Inc. Family CurrentSince Apr 1, 2022 Accepting new patients
Portland Opioid Health Home PastSince Jun 15, 2018 Accepting new patients
Constance W Jordan Anp Pmhnp PLLC PastSince Oct 22, 2023 Accepting new patients

Locations

Dept CH17590
Palatine, IL 60055

77 Park St
Rockland, ME 04841
Phone (207) 245-7654

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1770663734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 LAWN AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142071816",
            "telephone_number": "716-875-2904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 LAWN AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142071816",
            "telephone_number": "716-875-2904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "SUSAN",
        "middle_name": "G",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "AP081535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432097699",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.