NPIMap

Individual provider Active NPI

Rebecca M Martin, D.O.

  • Emergency Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1801874417
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
02001840A Issued in IN
Practice address
10906 W Sycamore Hills Dr
Fort Wayne, IN 46814-9334
Phone
(260) 625-5540
NPI assigned
Jan 4, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 02001840A IN Primary

Addresses

Primary practice location

10906 W Sycamore Hills Dr
Fort Wayne, IN 46814-9334

Mailing address

10906 W Sycamore Hills Dr
Fort Wayne, IN 46814-9334
Phone (260) 625-5540

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)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1388SCMDOptometrist
02001840AINMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Professionals of Indiana, P.C. Emergency Medicine Past Accepting new patients
Professional Emergency Physicians PC Emergency Medicine PastSince Jul 28, 2019 Accepting new patients
Mves Boardman LLC Emergency Medicine Past Accepting new patients
Nes Indiana, Inc. Emergency Medicine Past Accepting new patients
Mea-Aea Kenosha SC Emergency Medicine Past Accepting new patients
Northern Indiana Emergency Physicians, LLP Emergency Medicine Past Accepting new patients
Sturgis Emergency Physicians PLLC Emergency Medicine Past Accepting new patients
Community Memorial Hospital Past Accepting new patients
Midwest Medical Management, P.C. Emergency Medicine Past Accepting new patients
Reddy Pop Emergency Physicians Emergency Medicine Past Accepting new patients
Three Rivers Emergency Physicians PLLC Emergency Medicine Past Accepting new patients
Emergency Medicine of Indiana Emergency Medicine Past Accepting new patients

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801874417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10906 W SYCAMORE HILLS DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468149334",
            "telephone_number": "260-625-5540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10906 W SYCAMORE HILLS DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468149334",
            "telephone_number": "260-625-5540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "REBECCA",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "02001840A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.