NPIMap

Individual provider Active NPI

Martin J Repetto, MD

  • Psychiatry Physician
  • Mahomet, IL
National Provider Identifier
1881634228
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036118864 Issued in IL
Practice address
1504 Patton Dr
Mahomet, IL 61853-8144
Phone
(217) 586-2633
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X ME85073 FL
Psychiatry Physician 2084P0800X 036118864 IL Primary

Addresses

Primary practice location

1504 Patton Dr
Mahomet, IL 61853-8144

Mailing address

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-2579

Other practice location 1

1600 SW Archer Rd
Gainesville, FL 32610-0371
Phone (352) 265-7981

Other identifiers 1

IdentifierTypeStateIssuer
270255000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20071026000741 IL Practitioner - Psychiatry 9537136569 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pavilion FoundationGroup PAC ID 7911043740, 6 clinicians

Practice addresses (Care Compare)

1504 Patton Dr
Mahomet, IL 61853-8126
Phone (217) 586-2633

809 W Church St
Champaign, IL 61820-3320
Phone (217) 373-1700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME85073FLMDPsychiatry Physician
036118864ILMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association CurrentSince Sep 1, 2015 Accepting new patients
Pavilion Foundation CurrentSince Aug 3, 2009 Accepting new patients
Gibson Community Hospital Association CurrentSince Sep 1, 2015 Accepting new patients
Gibson Community Hospital Association Current Accepting new patients

Locations

809 W Church St
Champaign, IL 61820
Phone (217) 373-1700

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

4 Doctors Park
Gibson City, IL 60936
Phone (217) 784-4540

10 Doctors Park
Gibson City, IL 60936
Phone (217) 784-2650

1504 Patton Dr
Mahomet, IL 61853
Phone (217) 586-2633

Interoperability endpoints

  • Direct secure messaging: martin.repetto.p27@direct.gapho.nextgenshare.com
  • Direct secure messaging: martin.repetto.p58@direct.gapho.nextgenshare.com

Organizations & group practices 5

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1881634228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 N MELVIN ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361477",
            "telephone_number": "217-784-2579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 PATTON DR",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618538144",
            "telephone_number": "217-586-2633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326100371",
            "country_code": "US",
            "telephone_number": "352-265-7981",
            "fax_number": "352-265-7983",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REPETTO",
        "first_name": "MARTIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2024-08-05",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME85073",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036118864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270255000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mahomet, IL

Sources for this page

Verify at the official NPI Registry.