Crystal Martinez, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Dallas, NC
NPI 1972068757 · NPPES record last updated Sep 9, 2022
Key facts
- NPI
- 1972068757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 5011600 (NC)
- Practice address
- 3151 Dallas High Shoals Hwy Unit 935
Dallas, NC 28034-1369 - Phone
- (803) 470-5358
- NPI assigned
- Feb 5, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
110 Memory PLZ
Whiteville, NC 28472-2640
Phone (803) 470-5358
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200518003144 | NC | Practitioner - Nurse Practitioner | 9234560657 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 289876 | NC | MD | Family Nurse Practitioner |
| 5011600 | NC | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Odin Healthcare PLLC | Family | Current |
Accepting new patients |
| Coastal Southeastern United Care LLC | Current |
Accepting new patients | |
| Brightside Medical, P.C. | Past | Accepting new patients | |
| Whiteville Mat Services, Inc. | Past |
Accepting new patients |
Locations
3151 Dallas Hgh Shls Hwy
Unit 935
Dallas, NC 28034
Phone (803) 470-5358
3640 Express Dr
Shallotte, NC 28470
Phone (910) 294-8471
110 Memory Plz
Whiteville, NC 28472
Phone (803) 470-5358
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 289876 | NC | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 5011600 | NC | Yes |
Addresses
Primary practice location
3151 Dallas High Shoals Hwy Unit 935
Dallas, NC 28034-1369
Mailing address
3151 Dallas High Shoals Hwy Unit 935
Dallas, NC 28034-1369
Phone (803) 470-5358
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| F0290156 | Medicaid | NC |
Other providers in Dallas, NC
- Liberty Living, Inc
- Alice Jordan Lindo
- Meagan Lohr
- Maidtrix LLC
- Rebecca Mae Mapel
- Ashish Mehta
- Miata Mobile Hearing AIDS LLP
- Allyson Beth Middleton
- Mark Walter Miller
- Robert John Miller
All providers in Dallas, NC · Psychiatric/Mental Health Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.