NPIMap

Individual provider Active NPI

Marty Kelly Sanner, MD

  • Internal Medicine Physician
  • Lawton, OK
National Provider Identifier
1831183037
Registry record updated Aug 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
18448 Issued in OK
Practice address
4202 SW Lee Blvd
Ste 104
Lawton, OK 73505-8300
Phone
(580) 353-7777
Fax
(580) 248-8313
NPI assigned
Sep 2, 2005
Last updated
Aug 28, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 18448 OK Primary

Addresses

Primary practice location

4202 SW Lee Blvd
Ste 104
Lawton, OK 73505-8300

Mailing address

4202 SW Lee Blvd
Ste 104
Lawton, OK 73505-8300
Phone (580) 353-7777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20080624000602 OK Practitioner - Internal Medicine 6709957483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Oklahoma College of Medicine
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5404 SW Lee Blvd
Lawton, OK 73505-9521
Phone (580) 355-5242

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18448OKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Comanche County Hospital Authority CurrentSince Feb 5, 2019 Accepting new patients
Comanche County Hospital Authority CurrentSince Feb 5, 2019 Accepting new patients
Southwestern Surgical Affiliates, LLC Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Comanche County Healthcare Corporation Internal Medicine PastSince Apr 18, 2008 Accepting new patients
Comanche County Healthcare Past Accepting new patients
Summit Medical Center Past Accepting new patients
Comanche County Hospital Authority Past Accepting new patients

Locations

3201 W Gore Blvd
Ste 300
Lawton, OK 73505
Phone (580) 248-5255

3401 W Gore Blvd
Lawton, OK 73505
Phone (580) 483-5207

3811 W Gore Blvd
Ste 6
Lawton, OK 73505
Phone (580) 250-6525

5404 SW Lee Blvd
Lawton, OK 73505
Phone (580) 355-5242

5602 SW Lee Blvd
Lawton, OK 73505
Phone (580) 531-4700

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1821/brand/1/csg/22/fhir/r4
  • Direct secure messaging: marty.sanner@lawtoncommunityhealthcenter.eclinicaldirectplus.com

Organizations & group practices 9

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.

Hospital & facility affiliations 10

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": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219881600000",
    "number": "1831183037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 SW LEE BLVD",
            "address_2": "STE 104",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735058300",
            "telephone_number": "580-353-7777",
            "fax_number": "580-248-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 SW LEE BLVD",
            "address_2": "STE 104",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735058300",
            "telephone_number": "580-353-7777",
            "fax_number": "580-248-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANNER",
        "first_name": "MARTY",
        "middle_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2008-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "18448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.