Active NPI
Jatessa Jate Linn Martin
- Pharmacist
- Fort Dodge, IA
National Provider Identifier
1942803499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22862
- Practice address
- 2029 5TH Ave S
Fort Dodge, IA 50501-4307 - Phone
- (515) 955-6453
- NPI assigned
- Nov 18, 2020
- Last updated
- Nov 18, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 22862 | IA | Primary |
Addresses
Primary practice location
2029 5TH Ave S
Fort Dodge, IA 50501-4307
Mailing address
1352 N 14TH St
Fort Dodge, IA 50501-7532
Phone (712) 369-0015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22862 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iowa CVS Pharmacy LLC | Past | Accepting new patients | |
| Iowa CVS Pharmacy, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1942803499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1352 N 14TH ST",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505017532",
"telephone_number": "712-369-0015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2029 5TH AVE S",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505014307",
"telephone_number": "515-955-6453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JATESSA",
"middle_name": "JATE LINN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "22862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Dodge, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.