NPIMap

Individual provider Active NPI

Amy Martyanov, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Marquette, MI
National Provider Identifier
1922270768
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
4301099870 Issued in MI
Practice address
580 W College Ave
Marquette, MI 49855-2705
Phone
(906) 225-3993
NPI assigned
Apr 1, 2008
Last updated
Jul 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2006018424 MO
Neurology Physician 2084N0400X LT19894 ND
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 51192 MN
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 4301099870 MI Primary

Addresses

Primary practice location

580 W College Ave
Marquette, MI 49855-2705

Mailing address

2837 US 41 W
Marquette, MI 49855-2252
Phone (906) 225-3964

Other identifiers 1

IdentifierTypeStateIssuer
ENROLLEDMedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20081016000014 MN Practitioner - Neurology 3173681459 Reassigns benefits to 1 organization
I20120319000074 MI Practitioner - NeurologyPractitioner - Psychiatry 3173681459 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

1200 6TH Ave N
St Cloud, MN 56303-2735
Phone (320) 252-5131

850 W Baraga Ave
Marquette, MI 49855-4550
Phone (906) 449-3610

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2006018424MOMDPediatrics Physician
LT19894NDMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
DLP Marquette Physician Practices Inc CurrentSince Sep 12, 2012 Accepting new patients
Portage Physician Practices Inc CurrentSince Jan 1, 2014 Accepting new patients
DLP Marquette Physician Practices Inc CurrentSince Sep 12, 2012 Accepting new patients
Portage Physician Practices Inc Pediatrics CurrentSince Jan 1, 2014 Accepting new patients
McLaren Central Michigan Current Accepting new patients
Portage Hospital LLC CurrentSince May 24, 2014 Accepting new patients
Centracare Clinic CurrentSince Apr 13, 2024 Accepting new patients
McLaren Northern Michigan CurrentSince Apr 3, 2024 Accepting new patients
Centracare Clinic CurrentSince Apr 13, 2024 Accepting new patients
DLP Marquette Physician Practices Inc Pediatrics Current Accepting new patients
St. Francis Hospital Pediatrics CurrentSince Oct 14, 2024 Accepting new patients
St. Francis Hospital Current Accepting new patients
McLaren Central Michigan CurrentSince Aug 4, 2025 Accepting new patients
Portage Hospital LLC CurrentSince May 24, 2014 Accepting new patients
McLaren Northern Michigan CurrentSince Apr 3, 2024 Accepting new patients
McLaren Central Michigan CurrentSince Aug 4, 2025 Accepting new patients
Dickinson County Healthcare System Pediatrics CurrentSince Nov 1, 2024 Accepting new patients
St Francis Hospital CurrentSince Oct 14, 2024 Accepting new patients
DLP Conemaugh Physician Practices LLC Current Accepting new patients
Mayo Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients
Osf Multi-Specialty Group PastSince Jul 31, 2016 Accepting new patients

Locations

3409 Ludington St
Ste 104
Escanaba, MI 49829
Phone (906) 786-8343

3409 Ludington St
Ste 203
Escanaba, MI 49829
Phone (906) 428-5403

500 Campus Dr
Hancock, MI 49930
Phone (906) 483-1000

500 Campus Dr
Ste 5
Hancock, MI 49930
Phone (906) 483-1700

894 Campus Dr
Ste B
Hancock, MI 49930
Phone (906) 483-1128

1721 S Stephenson Ave
Iron Mountain, MI 49801
Phone (906) 776-5415

1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

850 W Baraga Ave
Ste 31
Marquette, MI 49855
Phone (906) 449-3600

1221 South Dr
Mt Pleasant, MI 48858
Phone (989) 772-6700

751 S 7th St
Ontonagon, MI 49953
Phone (906) 884-2824

2390 Mitchell Park Dr
Ste D
Petoskey, MI 49770
Phone (231) 242-1760

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

560 W Mitchell St
Ste 125
Petoskey, MI 49770
Phone (231) 487-3182

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

1450 Scalp Ave
Ste 2100
Johnstown, PA 15904
Phone (814) 269-5211

Interoperability endpoints

  • Direct secure messaging: amartyanov816992@direct.centracare.com
  • Direct secure messaging: amy.martyanov.1@8233.direct.athenahealth.com

Organizations & group practices 24

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.

View all 24

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1922270768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2837 US 41 W",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552252",
            "telephone_number": "906-225-3964",
            "fax_number": "906-226-3875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W COLLEGE AVE",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552705",
            "telephone_number": "906-225-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTYANOV",
        "first_name": "AMY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-01",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2006018424",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ND",
            "license": "LT19894",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MN",
            "license": "51192",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MI",
            "license": "4301099870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

Verify at the official NPI Registry.