Active NPI
Audra Martinez, DDS
- Dentist
- Rio Rancho, NM
National Provider Identifier
1891153615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD4645
- Practice address
- 4120 Barbara Loop SE
Rio Rancho, NM 87124-1000 - Phone
- (505) 892-8086
- Fax
- (505) 892-7976
- NPI assigned
- Feb 8, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD4645 | NM | Primary |
Addresses
Primary practice location
4120 Barbara Loop SE
Rio Rancho, NM 87124-1000
Mailing address
2436 Tyler Loop NE
Rio Rancho, NM 87144-6571
Phone (505) 401-0846
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160808002036 | NM | Order and Referring Only - Dentist | 9436443827 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690502400000",
"number": "1891153615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2436 TYLER LOOP NE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871446571",
"telephone_number": "505-401-0846",
"fax_number": "505-925-4030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 BARBARA LOOP SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871241000",
"telephone_number": "505-892-8086",
"fax_number": "505-892-7976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "AUDRA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-08",
"last_updated": "2023-07-28",
"certification_date": "2023-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD4645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.