Active NPI
Glen Wayne Martin
- Home Modifications Contractor
- Danville, IL
National Provider Identifier
1982349833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- B-0014
- Practice address
- 218 N Logan Ave
Danville, IL 61832-5655 - Phone
- (217) 431-0240
- NPI assigned
- May 4, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | B-0014 | IL | Primary |
Addresses
Primary practice location
218 N Logan Ave
Danville, IL 61832-5655
Mailing address
108 Lakeside Dr
Danville, IL 61832-1317
Phone (217) 497-0444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B-0014 | IL | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651622400000",
"number": "1982349833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 LAKESIDE DR",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618321317",
"telephone_number": "217-497-0444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 N LOGAN AVE",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618325655",
"telephone_number": "217-431-0240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "GLEN",
"middle_name": "WAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-04",
"last_updated": "2022-05-04",
"certification_date": "2022-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "IL",
"license": "B-0014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.