Daniel Allen Martin, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

331 Sijan Avenue
Whiteman AFB, MO 65305-1269

Phone

(405) 626-0333

NPI assigned

Jun 20, 2012

Last updated

Dec 15, 2021By 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

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1770846172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 SIJEN AVE",
            "city": "WHITEMAN AFB",
            "state": "MO",
            "postal_code": "653051269",
            "telephone_number": "405-626-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 SIJAN AVENUE",
            "city": "WHITEMAN AFB",
            "state": "MO",
            "postal_code": "653051269",
            "telephone_number": "405-626-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DANIEL",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-20",
        "last_updated": "2021-12-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Lang, APRN
• Michael Lee, RPH
• Jenna Clark Lewis, PSYD
• Adam Cochran Lynch, LCSW
• Brianne Daigh Manglitz, PA
• Michael William Martin, DDS, MD
• Kimberly A Mayberry, LSCSW
• Deborah Ann Nichols, LCSW
• Vanessa R. North, CNM, WHNP
• Douglas Melvin Odegaard Jr., RPH

• Physician Assistant in Whiteman AFB, MO
• Providers in Whiteman AFB, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.