Active NPI
Martin L Mayse, MD
- Pulmonary Disease Physician
- Saint Louis, MO
National Provider Identifier
1790701910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- 2003018930
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209185206 | Medicaid | MO |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 037980 | CT | MD | Licensed Practical Nurse |
| 2003018930 | MO | MD | Pulmonary Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Administrators of the Tulane Educational Fund | Past | Accepting new patients | |
| Masonicare Primary Care Physicians | Past | Accepting new patients | |
| Masonicare Behavioral Health, LLC | Past | 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.
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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.