Theodore Dale Martin, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP030516 Issued in PA

Practice address

7200 Peach St Unit 16
Erie, PA 16509-4756

Phone

(814) 877-4110

NPI assigned

Sep 4, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ucmg LLCGroup PAC ID 6709398969, 254 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theodore.d.martin@upmcdirect.com
• Direct secure messaging: tmartin163500@upmc.direct-ci.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.

• Ucmg LLC

  • Urgent Care Clinic/Center
  • Allison Park, PA
  • NPI 1972300622
  Medicare reassignment Care Compare group NPD
• Epn Hamot Urgent Care LLC

  • Family Medicine Physician
  • Erie, PA
  • NPI 1518283753
  Medicare reassignment NPD

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

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1841025418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 PEACH ST UNIT 16",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165094756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 PEACH ST UNIT 16",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165094756",
            "telephone_number": "814-877-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "THEODORE",
        "middle_name": "DALE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP030516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "theodore.d.martin@upmcdirect.com",
            "affiliation": "N",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dustin James Martin, DO
• Jayne L Martin, CRNP
• Kyle Lyn Martin, M.A. CCC-SLP
• Lauren Martin
• Matthew James Martin, PA-C
• Jasmin Maria Martinez Castellanos, M.D.
• Jacob Martinez
• Tiahana Marie Martinez, LCSW
• Moshood B Martins, MS
• Cheryl A Martinson

• Family Nurse Practitioner in Erie, PA
• Providers in Erie, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.