DR. FERNANDO MARTINEZ MD
NPI 1639334014
Pathology - Anatomic Pathology & Clinical Pathology in Miami, FL
Quality Rating: 73.45 out of 100 score
NPI Status: Active since July 24, 2008
- Individual
- Male
- Years of Experience 40
- Pathology
- Anatomic Pathology & Clinical Pathology
- Accepts Insurance
- Accepts Medicare Approved Payment
- PECOS Enrolled
About FERNANDO MARTINEZ
This page provides the complete NPI Profile along with additional information for Fernando Martinez, a provider established in Miami, Florida with a medical specialization in Pathology, focusing in anatomic pathology & clinical pathology and more than 40 years of experience. The healthcare provider is registered in the NPI registry with number 1639334014 assigned on July 2008. The practitioner's primary taxonomy code is 207ZP0102X with license number ME172399 (FL). The provider is registered as an individual and his NPI record was last updated March 2025.
- NPI
- 1639334014
- Provider Name
- DR. FERNANDO MARTINEZ MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 1400 NW 12TH AVE MIAMI, FL 33136
- Location Phone
- (305) 243-1111
- Mailing Address
- 1400 NW 12TH AVE MIAMI, FL 33136
- Mailing Phone
- (305) 243-1111
- Medical School Name
- OTHER
- Graduation Year
- 1986
- Is Sole Proprietor?
- No
- Enumeration Date
- 07-24-2008
- Last Update Date
- 03-04-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pathology Anatomic Pathology & Clinical Pathology
- Taxonomy Code
- 207ZP0102X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- ME172399
- License State
- FL
- Taxonomy Description
- A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
---|---|---|---|---|
1 | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | ME172399 (FL) |
2 | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | L8828 (TX) |
3 | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | ME172399 (FL) |
4 | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | L8828 (TX) |
5 | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | L8828 (TX) |
6 | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | ME172399 (FL) |
7 | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | L8828 (TX) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Advantage Bronze HMO? 204 - HMO
- Blue Advantage Bronze HMO? 301 - HMO
- Blue Advantage Bronze HMO? Standard - HMO
- Blue Advantage Gold HMO? 206 - HMO
- Blue Advantage Gold HMO? 603 - HMO
- Blue Advantage Gold HMO? Standard - HMO
- Blue Advantage Plus Bronze? 303 - POS
- Blue Advantage Plus Bronze? 305 - POS
- Blue Advantage Plus Bronze? Standard - POS
- Blue Advantage Plus Gold? 203 - POS
- Blue Advantage Plus Gold? 803 - POS
- Blue Advantage Plus Gold? Standard - POS
- Blue Advantage Plus Silver? 202 - POS
- Blue Advantage Plus Silver? 605 - POS
- Blue Advantage Plus Silver? Standard - POS
- Blue Advantage Security HMO? 200 - HMO
- Blue Advantage Silver HMO? 205 - HMO
- Blue Advantage Silver HMO? 801 - HMO
- Blue Advantage Silver HMO? Standard - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
Identifier | Type / Code | Identifier State | Identifier Issuer |
---|---|---|---|
196930501 | MEDICAID (05) | TX | |
1639334014 | MEDICAID (05) | TX | |
196930502 | OTHER (01) | TX | 196930502 |
196930502 | OTHER (01) | TX | CSHCN |
Medicare Participation & PECOS Enrollment Status
Fernando Martinez is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.
Fernando Martinez is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
PECOS PAC ID: 8224197140
What is the PECOS Associate Control ID?
A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.PECOS Enrollment ID: I20081107000054
What is the Provider Enrollment ID?
The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.Accepts Medicare Assignment? Yes
What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Blood bank physician services for cross match and/or evaluation and written report
Blood bank physician services for investigation of transfusion reaction with written report
Blood bank physician services with written report
Pathology clinical consultation for clinical problem, 5-20 minutes
Pathology clinical consultation for moderately complex clinical problem, 21-40 minutes
Blood bank physician services for cross match involve testing your blood against donor blood to ensure compatibility before a transfusion. The evaluation includes a detailed analysis of your blood type and antibodies. A written report will be provided, summarizing the findings.
This service was performed 1,695 times for 950 patientsThis service involves a blood bank doctor examining a patient's reaction to a blood transfusion. The doctor will conduct tests to identify the cause and provide a written report detailing the findings and recommendations for future care.
This service was performed 76 times for 54 patientsA blood bank physician service involves a specialized doctor overseeing all aspects of blood collection, storage, and transfusion. They ensure the process is safe and effective. A written report details all procedures and findings for your reference and understanding.
This service was performed 142 times for 111 patientsA pathology clinical consultation is a brief meeting with a medical expert to discuss health concerns. The consultation, lasting between 5-20 minutes, involves reviewing your medical history and possibly conducting tests to diagnose or understand your health condition better.
This service was performed 55 times for 47 patientsA pathology clinical consultation for a moderately complex problem involves a 21-40 minute discussion with a pathologist. The pathologist reviews your medical history, examines your test results, and provides insights about your health condition. They help in understanding your ailment better and suggest appropriate treatment options.
This service was performed 16 times for 15 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $35.39 for a new patient copayment and $26.79 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 33136 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $141.56
- Minimum New Patient Price $60.92
- Maximum New Patient Price $187.05
- Average New Patient Copayment $35.39
- Minimum New Patient Copayment $15.23
- Maximum New Patient Copayment $46.76
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $107.17
- Minimum Established Patient Price $18.99
- Maximum Established Patient Price $150.24
- Average Established Patient Copayment $26.79
- Minimum Established Patient Copayment $4.74
- Maximum Established Patient Copayment $37.56
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Overall MIPS Quality Performance
The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 73.45, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.
The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.
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Final Score: 73.45 out of 100
The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.
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Quality Score: 60.73
The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.
There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
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Promoting Interoperability Score: 100
The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.
The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data. -
Improvement Activities Score: 40
The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.
The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores. -
Cost Score: 43.61
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores. -
Cost Score: 43.61
The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
1 | 6 | 3 | 9 | 3 | 3 | 4 | 0 | 1 | 4 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 6 | 6 | 9 | 6 | 3 | 8 | 0 | 2 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 6 + 6 + 9 + 6 + 3 + 8 + 0 + 2 + 24 = 66 | |||||||||
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
70 - 66 = 4 | 4 |
The NPI number 1639334014 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
NPI | Name / Type | Taxonomy | Address |
---|---|---|---|
1659358778 | JOSE F ANGEL M.D. Individual | Anesthesiology | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5416 |
1013994177 | ALEXANDER FREYTAG M.D. Individual | Anesthesiology | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5416 |
1376520494 | JUAN HADDAD M.D. Individual | Anesthesiology | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5416 |
1700863834 | SANTIAGO LUIS M.D. Individual | Anesthesiology | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5416 |
1588642375 | JOSE BENGOCHEA M.D. Individual | Anesthesiology | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5416 |
1275511073 | LOURDES ACOSTA M.D. Individual | Anesthesiology | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5416 |
1417935230 | GUILLERMO TABLADA M.D. Individual | Anesthesiology | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5416 |
1952361941 | WENDY WHITTICK MD Individual | Radiology (Body Imaging) | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-3989 |
1487602777 | DR. DAVID M SEO MD Individual | Internal Medicine (Cardiovascular Disease) | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5511 |
1336199397 | SENG FOOK LAM CRNA Individual | Nurse Anesthetist, Certified Registered | 1400 NW 12TH AVE ANESTHESIA DEPT MIAMI, FL 33136 (305) 325-5416 |
1386695880 | DR. JASWINDER SINGH SANDHU M.D. Individual | Emergency Medicine | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 547-6468 |
1033161526 | ALEX PAGE M.D. Individual | Emergency Medicine | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 547-6468 |
1255383279 | PVL ASSOCIATES OF CEDARS INC Organization | Radiology (Diagnostic Radiology) | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5511 |
1477509446 | CEDARS HEALTHCARE GROUP, LTD. Organization | General Acute Care Hospital | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5511 |
1972550796 | CLAUDETE SCHIERHOLT CRNA Individual | Nurse Anesthetist, Certified Registered | 1400 NW 12TH AVE ANESTHESIA DEPARTMENT MIAMI, FL 33136 (305) 325-5416 |
1306885926 | JESUS VICTORIANO DIAZ CRNA Individual | Nurse Anesthetist, Certified Registered | 1400 NW 12TH AVE ANESTHESIA DEPARTMENT MIAMI, FL 33136 (305) 325-5416 |
1093742108 | RICARDO J. DESOUZA CRNA Individual | Nurse Anesthetist, Certified Registered | 1400 NW 12TH AVE ANESTHESIA DEPARTMENT MIAMI, FL 33136 (305) 325-5416 |
1144258724 | FRANCISCO A KERDEL MD Individual | Dermatology | 1400 NW 12TH AVE SUITE #4 MIAMI, FL 33136 (305) 324-2110 |
1952332421 | DOLORES M. GIBBS CRNA Individual | Nurse Anesthetist, Certified Registered | 1400 NW 12TH AVE DEPARTMENT OF ANESTHESIA MIAMI, FL 33136 (305) 325-5416 |
1124052113 | CARDIAC DIAGNOSTIC SERVICES INC Organization | Specialist | 1400 NW 12TH AVE MIAMI, FL 33136 (305) 325-5500 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1639334014, enumerated in the NPI registry as an "individual" on July 24, 2008
The provider is located at 1400 Nw 12th Ave Miami, Fl 33136 and the phone number is (305) 243-1111
The provider's speciality is Pathology with taxonomy code 207ZP0102X with a focus in Anatomic Pathology & Clinical Pathology
The provider has more than 40 years of experience.
The provider might be accepting Accepts: Blue Cross and Blue Shield of Texas, Medicare and. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
The provider has an overall high rating in the following quality measures: uses technology to exchange and make use of healthcare information.
Medicare beneficiaries should expect a typical cost of $141.56 with an average copayment of $35.39 for new patient appointments. Established patients should expect a typical charge of $107.17 and an average copayment of 26.79. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Blood bank physician services for cross match and/or evaluation and written report, Blood bank physician services for investigation of transfusion reaction with written report, Blood bank physician services with written report, Pathology clinical consultation for clinical problem, 5-20 minutes and Pathology clinical consultation for moderately complex clinical problem, 21-40 minutes.
This NPI record was last updated on July 24, 2008. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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