Tracy B Martin, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

99-PA28 Issued in NM

Practice address

2610 Trinity Dr Ste 14
Los Alamos, NM 87544-2362

Phone

(505) 500-8213

Fax

(505) 451-0580

NPI assigned

Dec 6, 2006

Last updated

Oct 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2022 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Satori Healing, LLC

  • Adult Medicine Physician
  • Los Alamos, NM
  • NPI 1699407072
  NPD
• Lutheran Hospital Association of the San Luis Valley

  dba San Luis Valley Health Regional Medical Center

  • General Acute Care Hospital
  • Alamosa, CO
  • NPI 1235181744
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1952460057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 TRINITY DR STE C3",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875442221",
            "telephone_number": "505-500-8213",
            "fax_number": "505-391-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 TRINITY DR STE 14",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875442362",
            "telephone_number": "505-500-8213",
            "fax_number": "505-451-0580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3500 Trinity Dr Ste C3",
            "address_purpose": "LOCATION",
            "city": "Los Alamos",
            "state": "NM",
            "postal_code": "875442221",
            "country_code": "US",
            "telephone_number": "505-500-8213",
            "fax_number": "505-391-8935",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TRACY",
        "middle_name": "B",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-06",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NM",
            "license": "99PA28",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "99-PA28",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000N1651",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOVELACE",
            "identifier": "10029201",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "QMP000003399104",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanne Malchow, CNM/FNP
• David Jake Maldonado, ATC, LAT
• Daniel Marancenbaum, MD
• Lisa Renee Marr Lyon, PH.D.
• Patrick Allen Martin, MD
• Elizabeth Martinez, LMT
• Pamela Nash Mathews, MSW, LISW, ACSW
• Elena Soliz McAtee, M.D.
• Robert S. McClees, M.D.
• Kayla McClellan

• Physician Assistant in Los Alamos, NM
• Providers in Los Alamos, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.