Marti M Gantt, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA07344 Issued in TX

Practice address

3200 W Highway 22
Corsicana, TX 75110-2449

Phone

(903) 875-2188

Fax

(903) 875-2186

NPI assigned

Jul 15, 2011

Sex

Female

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

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 Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1310688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1992093579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751510368",
            "telephone_number": "903-875-2188",
            "fax_number": "903-875-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 W HIGHWAY 22",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751102449",
            "telephone_number": "903-875-2188",
            "fax_number": "903-875-2186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANTT",
        "first_name": "MARTI",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-15",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA07344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Lee Gaines
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• Asa Nathaniel Gallup, D.D.S.
• Paula Deanne Gallup, D.D.S.
• Gantt Medical, PLLC
• Daphne Garrett
• Jennifer Lynn Gillen
• Shawn Ray Gillham, PT
• Jennifer Gilliam
• Adel M Gindy, MD

• Medical Physician Assistant in Corsicana, TX
• Providers in Corsicana, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; 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.