Individual provider Active NPI

Kristi Michaela Martinez, PA-C

  • Medical Physician Assistant
  • Saint Cloud, FL
National Provider Identifier
1942926746
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9116658 Issued in FL
Practice address
2906 17TH St
Saint Cloud, FL 34769-6006
Phone
(321) 841-7856
Fax
(321) 843-6432
NPI assigned
Oct 13, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9116658 FL
Medical Physician Assistant 363AM0700X PA9116658 FL Primary

Addresses

Primary practice location

2906 17TH St
Saint Cloud, FL 34769-6006

Mailing address

2906 17TH St
Saint Cloud, FL 34769-6006
Phone (321) 841-7856

Other practice location 1

100 N Dean Rd
Orlando, FL 32825-3710
Phone (407) 384-7388

Other identifiers 1

IdentifierTypeStateIssuer
124078800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241007000208 FL Practitioner - Physician Assistant 5799216412 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

2906 17TH St
Saint Cloud, FL 34769-6006
Phone (321) 841-7856

32 W Gore St
Orlando, FL 32806-1134

Hospital & facility affiliations

  • Orlando Health St Cloud Hospital Hospital, Saint Cloud, FL, CCN 100302

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9116658FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Sep 7, 2024 Accepting new patients

Locations

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

100 N Dean Rd
Orlando, FL 32825
Phone (407) 506-0006

2906 17th St
Saint Cloud, FL 34769
Phone (407) 425-4847

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 1

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 1

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": "1665619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1942926746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2906 17TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347696006",
            "telephone_number": "321-841-7856",
            "fax_number": "321-843-6432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2906 17TH ST",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347696006",
            "telephone_number": "321-841-7856",
            "fax_number": "321-843-6432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 N Dean Rd",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328253710",
            "country_code": "US",
            "telephone_number": "407-384-7388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "KRISTI",
        "middle_name": "MICHAELA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-13",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116658",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9116658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124078800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, FL

Sources for this page

Verify at the official NPI Registry.