Individual provider Active NPI

Kristin Nichole Marth, FNP

  • Family Nurse Practitioner
  • Peoria, AZ
National Provider Identifier
1972284131
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
295338 Issued in AZ
Practice address
9171 W Thunderbird Rd Ste 101
Peoria, AZ 85381-4872
Phone
(623) 877-0100
Fax
(623) 328-8713
NPI assigned
Jul 28, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 295338 AZ Primary

Addresses

Primary practice location

9171 W Thunderbird Rd Ste 101
Peoria, AZ 85381-4872

Mailing address

9171 W Thunderbird Rd Ste 101
Peoria, AZ 85381-4872
Phone (623) 877-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20231219003589 AZ Practitioner - Nurse Practitioner 1759731532 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prescott Healthcare Solutions LLCGroup PAC ID 4385940295, 199 clinicians

Practice addresses (Care Compare)

9171 W Thunderbird Rd
Suite 101
Peoria, AZ 85381-4872
Phone (623) 815-7800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
295338AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Elev CurrentSince Jul 1, 2023 Accepting new patients
Prescott Healthcare Solutions LLC Family CurrentSince Dec 14, 2023 Accepting new patients
Sundance Medical Associates PLLC Past Accepting new patients

Locations

9171 W Thunderbird Rd
Peoria, AZ 85381

8914 N 91st Ave
Ste 100
Peoria, AZ 85345
Phone (623) 877-0100

9171 W Thunderbird Rd
Ste 101
Peoria, AZ 85381
Phone (623) 877-0100

3151 N Windsong Dr
Prescott Vly, AZ 86314
Phone (928) 458-7583

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1972284131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9171 W THUNDERBIRD RD STE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814872",
            "telephone_number": "623-877-0100",
            "fax_number": "623-328-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9171 W THUNDERBIRD RD STE 101",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853814872",
            "telephone_number": "623-877-0100",
            "fax_number": "623-328-8713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTH",
        "first_name": "KRISTIN",
        "middle_name": "NICHOLE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-28",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "295338",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.