Colby Martin, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8829050-1206 Issued in UT

Practice address

115 Golf Course Rd Ste E
Logan, UT 84321-5934

Phone

(435) 999-4059

Fax

(435) 213-2800

NPI assigned

Nov 8, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Martin Medical Group LLC

  • Physician Assistant
  • Logan, UT
  • NPI 1467081448
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1383868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1982033098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 GOLF COURSE RD STE E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215934",
            "telephone_number": "435-999-4059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GOLF COURSE RD STE E",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843215934",
            "telephone_number": "435-999-4059",
            "fax_number": "435-213-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "COLBY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-08",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "8829050-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hazel Mariano, FNP, PMHNP
• Kali Leanne Markle, AUD
• Gregg Arthur Marshall, MD
• Martin Medical Group LLC
• Prafulla Martin-Garg, MD, FAAP
• Nicole Martin, SLP
• William Woodrow Martin, D.P.M
• Taylor Martindale, PA-C
• Angela M Martinez, LCSW
• Brynn Martinez, RBT

• Physician Assistant in Logan, UT
• Providers in Logan, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.