NPIMap

Individual provider Active NPI

Carolyn Johanna Martin, MD

  • Emergency Medicine Physician
  • Vancouver, WA
National Provider Identifier
1831175462
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD 60131801 Issued in WA
Practice address
400 NE Mother Joesph Place
Vancouver, WA 98664
Phone
(360) 514-2142
NPI assigned
Dec 15, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 25889 AZ
Emergency Medicine Physician 207P00000X MD27043 OR
Emergency Medicine Physician 207P00000X 01067726B IN
Emergency Medicine Physician 207P00000X MD 60131801 WA Primary

Addresses

Primary practice location

400 NE Mother Joesph Place
Vancouver, WA 98664

Mailing address

PO Box 1600
Vancouver, WA 98668-1600
Phone (360) 514-2142

Other identifiers 1

IdentifierTypeStateIssuer
1831175462MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100914000023 WA Practitioner - Emergency Medicine 7517969355 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Wayne State University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medicine Associates PCGroup PAC ID 3870526858, 37 clinicians

Practice addresses (Care Compare)

600 NE 92ND Ave
Vancouver, WA 98664-3225
Phone (360) 514-2142

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25889AZMDEmergency Medicine Physician
01067726BINMDEmergency Medicine Physician
MD27043ORMDEmergency Medicine Physician
MD 60131801WAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Associates PC Emergency Medicine CurrentSince Aug 11, 2011 Accepting new patients
Peacehealth CurrentSince Aug 10, 2011 Accepting new patients
Yakima Emergency Group a Professional Limited Liability Com Emergency Medicine Past Accepting new patients
Cep America LLC Emergency Medicine Past Accepting new patients
Cep America LLC Emergency Medicine Past Accepting new patients
Lewis County Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

600 NE 92nd Ave
Vancouver, WA 98664
Phone (360) 514-2142

Interoperability endpoints

  • Direct secure messaging: cmartin56245@direct.peacehealth.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1831175462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1600",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986681600",
            "telephone_number": "360-514-2142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NE MOTHER JOESPH PLACE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98664",
            "telephone_number": "360-514-2142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "CAROLYN",
        "middle_name": "JOHANNA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "25889",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD27043",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01067726B",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD 60131801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831175462",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.