NPIMap

Individual provider Active NPI

Stephanie Renee Martin, MD

  • Sports Medicine (Internal Medicine) Physician
  • Gambrills, MD
National Provider Identifier
1891992376
Registry record updated Apr 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
License
D73127 Issued in MD
Practice address
2401 Brandermill Blvd
Suite 250
Gambrills, MD 21054-1690
Phone
(410) 721-1507
Fax
(410) 721-1510
NPI assigned
Jun 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 0116019263 VA
Student in an Organized Health Care Education/Training Program 390200000X C7-0004604 DE
Sports Medicine (Internal Medicine) Physician 207RS0010X D73127 MD Primary

Addresses

Primary practice location

2401 Brandermill Blvd
Suite 250
Gambrills, MD 21054-1690

Mailing address

PO Box 12622
Belfast, ME 04915-4017
Phone (443) 481-6576

Other identifiers 5

IdentifierTypeStateIssuer
053826400MedicaidMD
K6440003OtherDCBCBS
97725101OtherMDBCBS
8527802OtherMDAETNA HMO
9936846OtherMDAETNA PPO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20120621000294 MD Practitioner - Internal MedicinePractitioner - Sports Medicine 3173787231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Sports Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Luminis Health Medical Group, LLC 540 clinicians

Practice addresses (Care Compare)

2003 Medical Pkwy
Annapolis, MD 21401-3081

2003 Medical Pkwy Wayson Pavillion
Advanced Internal Medicine Residenc
Annapolis, MD 21401-3081
Phone (443) 951-4286

Hospital & facility affiliations

  • Amedisys Home Health of Maryland Home health agency, Glen Burnie, MD, CCN 217108
  • Bayada Home Health Care, Inc. Home health agency, Towson, MD, CCN 217101
  • Centerwell Home Health Home health agency, Columbia, MD, CCN 217071
  • Luminis Health Anne Arundel Medical Center, Inc Hospital, Annapolis, MD, CCN 210023

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C7-0004604DEMDStudent in an Organized Health Care Education/Training Program
0116019263VAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Luminis Health Medical Group, LLC Current Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jul 2, 2012 Accepting new patients
Luminis Health Medical Group, LLC CurrentSince Jul 2, 2012 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

201 Defense Hwy
Ste 100
Annapolis, MD 21401
Phone (443) 481-6549

2003 Medical Pkwy
Ste 301
Annapolis, MD 21401
Phone (443) 481-3366

2401 Brandermill Blvd
Ste 250
Gambrills, MD 21054
Phone (410) 721-1507

Interoperability endpoints

  • Direct secure messaging: smartin24175@direct.aahs.org

Organizations & group practices 12

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 8

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": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427846400000",
    "number": "1891992376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12622",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154017",
            "telephone_number": "443-481-6576",
            "fax_number": "443-481-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 BRANDERMILL BLVD",
            "address_2": "SUITE 250",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541690",
            "telephone_number": "410-721-1507",
            "fax_number": "410-721-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "STEPHANIE",
        "middle_name": "RENEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2015-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116019263",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "DE",
            "license": "C7-0004604",
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "MD",
            "license": "D73127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053826400",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "K6440003",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "97725101",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "8527802",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "9936846",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gambrills, MD

Sources for this page

Verify at the official NPI Registry.