Concetta Whitley Martin, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PT2017-031 Issued in AR

Practice address

1652 State Highway 22 W
Dardanelle, AR 72834-2909

Phone

(479) 229-8000

Fax

(479) 477-3925

NPI assigned

May 19, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Kirkland Family Medical Center PAGroup PAC ID 7214063031, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Marys Regional Medical Center Hospital, Russellville, AR, CCN 040041

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: concetta.martin.1@2110.direct.athenahealth.com

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.

• The Kirkland Family Medical Center, PA

  • Preferred Provider Organization
  • Dardanelle, AR
  • NPI 1316145022

  AR

  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Russellville Holdings LLC

  • General Acute Care Hospital
  • Russellville, AR
  • NPI 1033160049

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1495152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1821525916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1652 STATE HIGHWAY 22 W",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "728342909",
            "telephone_number": "479-229-8000",
            "fax_number": "479-477-3925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1652 STATE HIGHWAY 22 W",
            "city": "DARDANELLE",
            "state": "AR",
            "postal_code": "728342909",
            "telephone_number": "479-229-8000",
            "fax_number": "479-477-3925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CONCETTA",
        "middle_name": "WHITLEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-19",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "PT2017-031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS STATE MEDICAL BOARD",
            "identifier": "PT2017-031",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jena Wynne Lee, RDN, LD
• Sarah V. Lewers, SLP
• Andrea Luker, APRN, FNP-BC, FNP-C
• Stephen N Luker, DO
• Amy Bell Lynch, MS, RD, LD
• McCormick Family Dentistry
• Michael D McCormick, DDS
• William Michael McCormick, D.D.S.
• Virginia Mistler, APRN
• Dennis Molina-Aguilar, DDS

• All providers in Dardanelle, AR
• Medical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.
• 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.

Verify at the official NPI Registry.