2026 NPPES data Rheumatology Physician NPI 1366476897 M.D.
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CARLOS MARTINEZ, M.D.

Rheumatology Physician in WEST SENECA, New York. CMS National Plan and Provider Enumeration System profile including specialty classification, practice address, and Medicare prescribing data when reported.

Federal data — no proprietary rating. PlainDoctor publishes the actual CMS NPPES and Medicare records — NPI registration, specialty, practice location, and prescribing data — without a composite score or editorial opinion on top. Every field traces to a federal source.
Prescribing volume
2K
Medicare Part D claims · 471 beneficiaries · Rheumatology Physician avg: 2K
Generic prescribing
87%
generic claims · 13% brand-name · higher generic rates reduce patient out-of-pocket costs
MIPS score
94.7459/100
▲ 12 pts above national avg 83.1 · [object Object]
Industry payments
$2.9K
111 payments · CMS Open Payments (Sunshine Act)

What the federal data shows

CARLOS MARTINEZ, M.D. reported a CMS MIPS final score of 94.7459/100 — above the 83.1 national average — and filed 1,682 Medicare Part D claims in 2023.

94.7459/100
MIPS score · +12 vs avg
2K
Part D claims, 2023
87%
generic prescribing
Likely
board-certified (heuristic)

Every figure on this page comes straight from federal CMS records (NPPES, Medicare Part D, MIPS, Open Payments) — no proprietary rating or editorial opinion is applied.

CARLOS MARTINEZ, M.D.'s MIPS score vs every scored U.S. clinician

CMS Merit-based Incentive Payment System (MIPS) final score, 2023 — the federal quality measure

95 Top 25% higher than 75% of 477,587 scored providers

0–10: 8,684 scored providers (2%). Below this entry. 10–20: 3,008 scored providers (1%). Below this entry. 20–30: 3,069 scored providers (1%). Below this entry. 30–40: 2,746 scored providers (1%). Below this entry. 40–50: 2,928 scored providers (1%). Below this entry. 50–60: 5,882 scored providers (1%). Below this entry. 60–70: 13,906 scored providers (3%). Below this entry. 70–80: 118,074 scored providers (25%). Below this entry. 80–90: 129,887 scored providers (27%). Below this entry. 90–100: 189,403 scored providers (40%). This entry sits in this band. This provider 0 100 every MIPS-scored clinician, bucketed by value

Each bar is a band; taller bars hold more scored providers. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.

Source CMS Merit-based Incentive Payment System (MIPS) · 2023

Board certification likely (heuristic — not verified)

CARLOS MARTINEZ, M.D. practices in an ABMS-board-eligible specialty and shows active CMS Medicare participation + MIPS quality reporting + 2 hospital affiliations — signals consistent with board-certified status. For verified board certification, see CertificationMatters.org (the official ABMS public lookup).

What does the federal data show about CARLOS MARTINEZ, M.D.?

High performer (top quartile)

NPI registry status

Active

Issued 07/10/2006

NPI 1366476897

Primary specialty

Rheumatology Physician

Mid-sized

6,181 US NPIs in this specialty

Medicare Part D claims

1,682 18% vs specialty avg

2023 prescription claims

Specialty avg: 2,054

MIPS final score

94.7459/100 11.645900000000012% pts

Exceptional band

vs 83.1 national avg

Specialty distribution in New York

How Rheumatology Physician compares to other specialties among New York providers

New York providers

Rheumatology Physician share within New York

1. Rheumatology Physician42%2. Internal medicine21%3. Family medicine17%4. Surgical12%5. Pediatric8%
Rheumatology Physician share within New York

Medicare quality performance — MIPS

CARLOS MARTINEZ, M.D.'s 2023 MIPS final score plotted against the Rheumatology Physician national average

High performer (top quartile)
MIPS Final Score
94.7459/100
vs 83.1 national avg · 2023 performance year

MIPS final score (Rheumatology Physician) — 94.7459/100 vs national avg 83.1

0%100%National avg83%94.7%
MIPS final score (Rheumatology Physician) — 94.7459/100 vs national avg 83.1

The Merit-based Incentive Payment System (MIPS) scores providers 0–100 across four performance categories: Quality, Cost, Promoting Interoperability, and Improvement Activities, weighted under 42 CFR §414.1380. Reporting is voluntary for many small practices, so absence of a MIPS score is not a quality signal.

Board certification through an ABMS or AOA member board signals voluntary post-licensure examination plus continuous Maintenance of Certification cycles. Verify any individual provider's status through certificationmatters.org (ABMS) or osteopathic.org (AOA).

CARLOS MARTINEZ, M.D. appears in the CMS NPPES registry as a Rheumatology Physician provider holding M.D. credentials at 2291 UNION RD, WEST SENECA, NY, 14224, with a listed phone of (716) 668-6146. NPI 1366476897 was issued on 07/10/2006. Because NPPES data is self-reported by the provider and refreshed monthly, the address, phone, and specialty reflect what MARTINEZ most recently submitted to CMS rather than a vetted directory listing, which is why patients should always confirm the practice is still at this location before scheduling.

Medicare Part D records for calendar year 2023 show 1,682 prescription claims written by this provider, covering 471 Medicare beneficiaries and totaling roughly $683K in drug spend, split 13% brand-name and 87% generic by claim count, with an opioid prescribing rate of 9.9%. These figures capture only Medicare Part D — commercial insurance, Medicaid, and cash-pay prescriptions are not included, and any drug-beneficiary cell under 11 is suppressed by CMS for patient privacy. On the CMS Merit-based Incentive Payment System, this provider earned a Final Score of 94.7459/100 for the 2023 performance year (Quality 85.8196, Cost 100), compared with the national average of 83.1.

Rheumatology Physician is a mid-sized specialty nationwide, with 6,181 enrolled providers across 52 states and an average of 2,054 Part D claims per prescriber, so the context for interpreting these metrics differs meaningfully from a primary-care baseline. Important: PlainDoctor is a directory of publicly available government data, not medical advice, a malpractice database, or a quality rating. Inclusion here does not imply a recommendation, and absence of complaints or sanctions on this page does not mean none exist — always verify credentials through the NPPES NPI Registry, your state medical board, and the ABMS or AOA before making healthcare decisions.

Practice Address

2291 UNION RD
WEST SENECA, NY 14224

Provider Details

NPI 1366476897
Specialty Rheumatology Physician
Credentials M.D.
Gender Male
NPI Issued 07/10/2006

CMS Quality Score (MIPS)

Merit-based Incentive Payment System (MIPS) scores from CMS, 2023 performance year.

94.7459
Final Score
Avg: 83.1
85.8196
Quality
100
Cost
96
Promoting Interoperability

Reporting: Group practice

Hospital and facility affiliations

Facilities where CARLOS MARTINEZ, M.D. bills Medicare from. Star ratings (1-5) are CMS Hospital Compare's "Hospital overall rating" — a composite of mortality, readmission, patient experience, safety, timely care, and efficient use of medical imaging measures. Source: CMS Care Compare.

CARLOS L MARTINEZ MD PC
WEST SENECA, NY
PREFERRED PHYSICIAN CARE PC
WILIAMSVILLE, NY

Affiliations sourced from CMS Doctors and Clinicians National Downloadable File; hospital ratings from CMS Hospital General Information dataset (cross-referenced by facility name + state).

Industry payments received (2024) — CMS Open Payments transparency data

The federal Physician Payments Sunshine Act (part of the Affordable Care Act) requires drug and medical-device manufacturers + group purchasing organizations to publicly report payments and other transfers of value to physicians and teaching hospitals. The data below covers 2024 for CARLOS MARTINEZ, M.D.. Source: openpaymentsdata.cms.gov.

Total received

$2.9K

Largest payer

ABBVIE INC.

Most common payment type

Food and Beverage

Industry payments are not necessarily indicators of bias — they include research funding, consulting fees for evidence-based work, royalties for inventions, food at conferences, and similar items. The disclosure exists for transparency. Read our methodology for how we interpret this data.

License & disciplinary context — New York NYSBPMC 2023 annual report

Aggregate state board data only — NOT a determination of any individual provider's status. The figures below describe statewide disciplinary activity across all ~100K New York medical licensees in 2023 — they are NOT specific to CARLOS MARTINEZ, M.D.. To verify CARLOS MARTINEZ, M.D.'s current license status, search the NYSBPMC public license lookup directly, or check the Federation of State Medical Boards (FSMB) verification service.

312
Total board actions, New York 2023
Across 302 cases
3.12
Actions per 1,000 licensees
New York statewide rate
probation
Most common action type
89 cases

NYSBPMC publishes annual disciplinary statistics as part of public-record reporting under each state's Administrative Procedure Act. See the full breakdown by action type and year on the New York disciplinary trends page. Cross-checked against FSMB U.S. Medical Regulatory Trends.

Brand vs generic prescribing mix · Typical

CARLOS MARTINEZ, M.D. — brand share 13.0%
Specialty average (est.)

13% brand-name claims vs 87% generic, on 1,682 2023 Medicare Part D claims.

The federal Medicare Part D Generic Dispensing Rate national benchmark sits near 90% generic / 10% brand for primary-care prescribers, per CMS Office of the Actuary 2024 estimates. Higher brand share is common in specialty prescribing where generic equivalents are not available.

Medicare Part D Prescribing Data

CMS Medicare Part D prescriber-level data for calendar year 2023.

1,682
Total Claims
$683K
Total Drug Cost
471
Medicare Beneficiaries

Prescribing Breakdown

30-Day Fills
2,472
Total Day Supply
71,192
Brand vs Generic
13% brand / 87% generic
Brand Drug Cost
$647K
Generic Drug Cost
$34K
Opioid Claims
167 (9.9% rate)
Antibiotic Claims
34

Patient Demographics

Average Patient Age
72.1 years
Avg HCC Risk Score
1.44
Gender Split
73% female / 27% male
Age Distribution
<65: 66, 65-74: 219, 75-84: 152, 85+: 34

Top Prescribed Drugs (Medicare Part D)

Top drugs by claim count for calendar year 2023. Based on Medicare Part D data only.

What CARLOS MARTINEZ, M.D. prescribes most

Top Medicare Part D drugs by claim count, 2023

claims
Source CMS Medicare Part D Prescriber Public Use File As of 2023
Drug Claims
Methotrexate
Methotrexate Sodium
152
Celecoxib
145
Hydrocodone-Acetaminophen
Hydrocodone/Acetaminophen
143
Prednisone
120
Leflunomide
96
Hydroxychloroquine Sulfate
77
Duloxetine Hcl
59
Sulfasalazine
51
Gabapentin
36
Allopurinol
33

* Counts below 11 are suppressed by CMS for patient privacy. Generic names shown where available from CMS Part D data.

Rheumatology Physician Overview

How CARLOS MARTINEZ, M.D. fits within the Rheumatology Physician landscape nationally.

6,181
Rheumatology Physician Providers in US
52
States with Rheumatology Physician
2,054
Avg Claims per Provider

CARLOS MARTINEZ, M.D.'s 1,682 claims are below the specialty average of 2,054.

Nearby Rheumatology Physician Providers in New York

Other clinicians with the same primary specialty enrolled in New York, drawn from the same CMS NPPES roster as MARTINEZ.

Compare Rheumatology Physician nationally: see state-by-state distribution →

Frequently Asked Questions

What is CARLOS MARTINEZ, M.D.'s specialty?
CARLOS MARTINEZ, M.D. specializes in Rheumatology Physician and practices in WEST SENECA, New York. Credentials: M.D..
How much does CARLOS MARTINEZ, M.D. prescribe under Medicare Part D?
In 2023, CARLOS MARTINEZ, M.D. wrote 1,682 Medicare Part D claims totaling $683K in drug costs for 471 beneficiaries.
What is CARLOS MARTINEZ, M.D.'s Medicare quality score?
CARLOS MARTINEZ, M.D. has a CMS MIPS Final Score of 94.7459/100 (Quality: 85.8196, Cost: 100). The national average MIPS Final Score is 83.1. Source: CMS Merit-based Incentive Payment System (MIPS) 2023.
Where is CARLOS MARTINEZ, M.D. located?
CARLOS MARTINEZ, M.D. is located at 2291 UNION RD, WEST SENECA, NY, 14224. Phone: (716) 668-6146.
What is CARLOS MARTINEZ, M.D.'s NPI number?
CARLOS MARTINEZ, M.D.'s National Provider Identifier (NPI) is 1366476897, issued on 07/10/2006.
Does CARLOS MARTINEZ, M.D. prescribe more brand-name or generic drugs?
CARLOS MARTINEZ, M.D.'s prescribing is 13% brand-name and 87% generic drugs by claim count, with $647K in brand drug costs.
Does CARLOS MARTINEZ, M.D. prescribe opioids?
Yes, CARLOS MARTINEZ, M.D. had 167 opioid claims in 2023 with an opioid prescribing rate of 9.9%.
How many Rheumatology Physician providers are there in the US?
There are 6,181 Rheumatology Physician providers across 52 states in the US. The average Rheumatology Physician provider writes 2,054 Medicare Part D claims per year.
What drugs does CARLOS MARTINEZ, M.D. prescribe most often?
Based on 2023 Medicare Part D data, CARLOS MARTINEZ, M.D.'s most frequently prescribed drugs include Methotrexate, Celecoxib, Hydrocodone-Acetaminophen. This reflects Medicare Part D prescriptions only and does not include commercial insurance or other payer types.
Does CARLOS MARTINEZ, M.D. accept Medicare?
CARLOS MARTINEZ, M.D. appears in CMS Medicare data with 1,682 Part D claims and 471 Medicare beneficiaries in 2023. Contact the provider's office directly to confirm current Medicare enrollment and accepted plans.
How can I verify CARLOS MARTINEZ, M.D.'s credentials?
CARLOS MARTINEZ, M.D.'s NPI is 1366476897 with credentials M.D.. You can verify this through the NPPES NPI Registry, check state medical board records, and confirm board certification through the ABMS or AOA.

Data Sources

Provider Directory
CMS National Plan and Provider Enumeration System (NPPES), download.cms.gov/nppes, updated monthly. Contains NPI, specialty, credentials, and practice location.
Specialty Classification
NUCC Health Care Provider Taxonomy (nucc.org), the industry standard for classifying provider specialties in Medicare and Medicaid billing.
Prescribing Data
CMS Medicare Part D Prescriber Public Use File (2023). Includes claims, drug costs, beneficiaries, and opioid prescribing rates.
Quality Performance
CMS Merit-based Incentive Payment System (MIPS) — 2023 performance year.
Limitations
Provider data is self-reported to CMS. Prescribing data reflects Medicare Part D only and does not include commercial insurance, Medicaid, or cash prescriptions. Claims below 11 beneficiaries are suppressed by CMS for privacy.

See our complete data methodology for details on how we collect and process government data.

Data as of April 2026 (NPPES) / 2023 (Medicare Part D). Source: Centers for Medicare & Medicaid Services (CMS).

Disclaimer: Data from CMS NPPES and Medicare Part D. PlainDoctor does not rate or rank providers. Provider information is self-reported and may not be current. Always verify information directly with the provider. About · Methodology