NPIMap

Individual provider Active NPI

Donald Patrick Martin, MD

  • Family Medicine Physician
  • South Lake Tahoe, CA
National Provider Identifier
1780679779
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A063596 Issued in CA
Practice address
1108 4TH Street
South Lake Tahoe, CA 96150
Phone
(530) 542-5740
Fax
(530) 542-5743
NPI assigned
Sep 15, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A063596 CA Primary

Addresses

Primary practice location

1108 4TH Street
South Lake Tahoe, CA 96150

Mailing address

1108 4TH Street
South Lake Tahoe, CA 96150
Phone (530) 542-5740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060119000670 CA Practitioner - Family Practice 8022032838 Reassigns benefits to 1 organization
Practice locations: South Lake Tahoe, CA

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Tulane University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barton Medical FoundationGroup PAC ID 5395127682, 97 clinicians

Practice addresses (Care Compare)

1108 4TH St
South Lake Tahoe, CA 96150-3476
Phone (530) 543-5750

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.71 of 100Reported as apm
Quality
89.85
Promoting interoperability
94.05
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.42 of 100Reported as group
Quality
93.48
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions30

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A063596CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Barton Medical Foundation Family Medicine CurrentSince Oct 11, 2022 Accepting new patients
Barton Healthcare System Past Accepting new patients

Locations

2074 Lake Tahoe Blvd
Ste 4
South Lake Tahoe, CA 96150
Phone (530) 543-5554

2170 South Ave
South Lake Tahoe, CA 96150
Phone (530) 541-3420

1108 4th St
South Lake Tahoe, CA 96150
Phone (530) 542-5740

Interoperability endpoints

  • Direct secure messaging: dmartin87453@direct.renown.org

Organizations & group practices 2

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1780679779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 4TH STREET",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "96150",
            "telephone_number": "530-542-5740",
            "fax_number": "530-542-5743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 4TH STREET",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "96150",
            "telephone_number": "530-542-5740",
            "fax_number": "530-542-5743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "DONALD",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-15",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A063596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.