Individual provider Active NPI

Martin L Mayse, MD

  • Pulmonary Disease Physician
  • Saint Louis, MO
National Provider Identifier
1790701910
Registry record updated Jan 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
2003018930 Issued in MO
Practice address
4960 Childrens PL
Saint Louis, MO 63110-1000
Phone
(314) 454-8917
Fax
(314) 454-5571
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 2003018930 MO Primary

Addresses

Primary practice location

4960 Childrens PL
Saint Louis, MO 63110-1000

Mailing address

660 S Euclid Ave
C B 8052
Saint Louis, MO 63110-1010
Phone (314) 454-8917

Other identifiers 1

IdentifierTypeStateIssuer
209185206MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
037980CTMDLicensed Practical Nurse
2003018930MOMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Administrators of the Tulane Educational Fund Past Accepting new patients
Masonicare Primary Care Physicians PastSince Oct 1, 2001 Accepting new patients
Masonicare Behavioral Health, LLC PastSince Dec 17, 2007 Accepting new patients

Organizations & group practices 3

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233014400000",
    "number": "1790701910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "C B 8052",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-454-8917",
            "fax_number": "314-454-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4960 CHILDRENS PL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101000",
            "telephone_number": "314-454-8917",
            "fax_number": "314-454-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYSE",
        "first_name": "MARTIN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2009-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MO",
            "license": "2003018930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209185206",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.