Nicole Michelle Martinez, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

265640 Issued in NY

Practice address

845 N New Ballas CT Ste 360
Creve Coeur, MO 63141-7124

Phone

(314) 219-1247

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• Baylor College of Medicine

  • Surgery Physician
  • Houston, TX
  • NPI 1225072291
  NPD (past)

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1780894113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N NEW BALLAS CT STE 360",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417124",
            "telephone_number": "314-219-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N NEW BALLAS CT STE 360",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417124",
            "telephone_number": "314-219-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "NICOLE",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "N0250",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "265640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03504267",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102784987",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marlon G Mangahas MD LLC
• Thao Tran Marquez, MD,MS
• Tammy Anne Martielli, PH.D.
• Alayna Martin, SLP
• Corey Martin
• Krysta Shaye Maskey, FNP
• Sara Emma Massie
• Abigail Mather, MS, NCC, LPC
• Allen E Mathieu, PAC,ATC,MS
• Bradley Steven Matthes, DDS

• Surgery Physician in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.