Stacy Ann Martin, MD
Individual provider Active NPI Emergency Medical Services (Emergency Medicine) Physician · American Fork, UT
NPI 1891748315 · NPPES record last updated Apr 9, 2021
Key facts
- NPI
- 1891748315
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician 207PE0004X
- License
- 341513 (UT)
- Practice address
- 170 North 1100 East
American Fork, UT 84003 - Phone
- (801) 714-6570
- NPI assigned
- May 18, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- University of Utah School of Medicine, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Big Horn County Hospital District
Practice addresses (Care Compare)
388 US Hwy 20 S
Basin, WY 82410-8902
Phone (307) 568-3311
Hospital & facility affiliations
- South Big Horn County Hospital
- Cody Regional Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in UT, GU, WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110121000186 | UT | Practitioner - Emergency Medicine | 1557460706 | Reassigns benefits to 1 organization |
| I20190115000256 | GU | Practitioner - Emergency Medicine | 1557460706 | Reassigns benefits to 1 organization |
| I20230522000203 | WY | Practitioner - Emergency Medicine | 1557460706 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| EMTL-2020-001 | GU | MD | Emergency Medicine Physician |
| 341513 | UT | MD | Emergency Medical Services (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guam Healthcare Development Incorporated | Current |
Accepting new patients | |
| South Big Horn County Hospital District | Current |
Accepting new patients | |
| South Big Horn County Hospital District | Current |
Accepting new patients | |
| South Big Horn County Hospital District | Current | Accepting new patients | |
| Emergency Physicians Integrated Care, LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
133 Route 3
Dededo, GU 96929
Phone (671) 645-5500
1600 W Antelope Dr
Layton, UT 84041
Phone (801) 807-1000
630 Medical Dr
North Salt Lake, UT 84010
Phone (801) 292-6231
2690 N 600 W
Pleasant View, UT 84414
Phone (801) 786-7911
3451 W 5600 S
Roy, UT 84067
Phone (801) 896-5600
1050 E South Temple
Slc, UT 84102
Phone (801) 350-4111
2055 N Main St
Tooele, UT 84074
Phone (435) 843-3600
3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810
3460 S Pioneer Pkwy
West Valley City, UT 84120
Phone (801) 964-3111
388 US Highway 20 S
Basin, WY 82410
Phone (307) 347-5810
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | EMTL-2020-001 | GU | |
| Emergency Medicine Physician | 207P00000X | MTL-2018-027 | GU | |
| Emergency Medicine Physician | 207P00000X | M-2221 | GU | |
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 341513 | UT | Yes |
Addresses
Primary practice location
170 North 1100 East
American Fork, UT 84003
Mailing address
PO Box 430
Spanish Fork, UT 84660-0430
Phone (866) 898-7136
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 491910 | Other | UT | DESERET MUTUAL |
| 97341513101001 | Other | UT | BCBS |
| 107008020102 | Other | UT | SELECT HEALTH |
| D2015 | Medicaid | UT | |
| 870636000MA1 | Other | UT | EDUCATORS MUTUAL |
Other providers in American Fork, UT
- Abygail Marble
- Mark Henry Radandt
- Mark T Saunders MD LC
- Marlan Hansen MD LLC
- Amber Dawn Martin
- Minerva Esmeralda Martinez-Lopez
- Holly Martinez
- Maria Myers Martinez
- Brian M Matthews
- Ana P Mattson
All providers in American Fork, UT · Emergency Medical Services (Emergency Medicine) Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.