Active NPI
Carlisle L St. Martin, M.D.
- Neurology Physician
- Forest Hills, NY
National Provider Identifier
1790764348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 153547
- Practice address
- 115-10 Queens Blvd
Forest Hills, NY 11375-7060 - Phone
- (718) 520-0808
- Fax
- (718) 544-0972
- NPI assigned
- Jan 12, 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 153547 | NY | Primary |
Addresses
Primary practice location
115-10 Queens Blvd
Forest Hills, NY 11375-7060
Mailing address
11510 Queens Blvd
Forest Hills, NY 11375-7060
Phone (718) 520-0808
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00822028 | Medicaid | NY |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080911000367 | NY | Practitioner - Neurology | 4284700402 | Practice locations: Forest Hills, NY |
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- State University of New York Downstate Medical Center, 1975
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
11510 Queens Blvd
Forest Hills, NY 11375-7015
Phone (718) 520-0808
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153547 | NY | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214956800000",
"number": "1790764348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11510 QUEENS BLVD",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113757060",
"telephone_number": "718-520-0808",
"fax_number": "718-544-0972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115-10 QUEENS BLVD",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113757060",
"telephone_number": "718-520-0808",
"fax_number": "718-544-0972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ST. MARTIN",
"first_name": "CARLISLE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-12",
"last_updated": "2008-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "153547",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00822028",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.