NPIMap

Individual provider Active NPI

Vince Russell Martin, P.A.

  • Medical Physician Assistant
  • Sallisaw, OK
National Provider Identifier
1942329636
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1514 Issued in OK
Practice address
700 W Cherokee Ave
Sallisaw, OK 74955-4216
Phone
(918) 775-0007
Fax
(918) 775-8910
NPI assigned
Mar 27, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1514 OK Primary

Addresses

Primary practice location

700 W Cherokee Ave
Sallisaw, OK 74955-4216

Mailing address

700 W Cherokee Ave
Sallisaw, OK 74955-4216
Phone (918) 775-0007

Other identifiers 2

IdentifierTypeStateIssuer
34366OtherOKOK BUR OF NARCOTICS & DD
1514OtherOKOKLAHOMA LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20071115000629 MO Practitioner - Physician Assistant 6800984345 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

1605 Martin Springs Dr
Rolla, MO 65401-2980

1965 S Fremont Ave
230 MC General and Trauma Surgery
Springfield, MO 65804-2258
Phone (417) 820-7250

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1514OKMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Springfield CurrentSince Dec 7, 2024 Accepting new patients
Mercy Hospital Springfield CurrentSince Dec 7, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 17, 2007 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 18, 2007 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Sep 17, 2007 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

3231 S National Ave
Springfield, MO 65807
Phone (417) 829-4444

Organizations & group practices 7

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 9

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": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1942329636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W CHEROKEE AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554216",
            "telephone_number": "918-775-0007",
            "fax_number": "918-775-8910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W CHEROKEE AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554216",
            "telephone_number": "918-775-0007",
            "fax_number": "918-775-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "VINCE",
        "middle_name": "RUSSELL",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OK BUR OF NARCOTICS & DD",
            "identifier": "34366",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA LICENSE",
            "identifier": "1514",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sallisaw, OK

Sources for this page

Verify at the official NPI Registry.