NPIMap

Individual provider Active NPI

Kopriva Marie Martin, MD

  • Hospitalist Physician
  • Winston Salem, NC
National Provider Identifier
1891061412
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
MD61025441 Issued in WA
Practice address
3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone
(336) 718-6479
Fax
(336) 718-9622
NPI assigned
Mar 28, 2012
Last updated
Apr 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2015-00658 NC
Internal Medicine Physician 207R00000X 40136 SC
Hospitalist Physician 208M00000X MD61025441 WA Primary
Hospitalist Physician 208M00000X 2015-00658 NC

Addresses

Primary practice location

3333 Silas Creek Pkwy
Winston Salem, NC 27103

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 718-6479

Other identifiers 1

IdentifierTypeStateIssuer
401363MedicaidSC

Other names 1

  • Kopriva Marie Marshall Former name

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
I20200427000432 WA Practitioner - Hospitalist 2668793506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

311 S L St
Tacoma, WA 98405-3720

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD61025441WAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Apr 13, 2020 Accepting new patients
Multicare Health System CurrentSince Apr 13, 2020 Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

Interoperability endpoints

  • Direct secure messaging: kmartin462672@direct.multicare.org

Organizations & group practices 3

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 3

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": "1332892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587427200000",
    "number": "1891061412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-718-6479",
            "fax_number": "336-718-9622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 SILAS CREEK PKWY",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-718-6479",
            "fax_number": "336-718-9622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KOPRIVA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-28",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2015-00658",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "40136",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD61025441",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2015-00658",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401363",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KOPRIVA",
            "last_name": "MARSHALL",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.