NPIMap

Individual provider Active NPI

Justin Vaughan, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Macon, GA
National Provider Identifier
1083025886
Registry record updated Nov 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
777 Hemlock St
MSC 140
Macon, GA 31201-2102
Phone
(478) 633-8115
Fax
(478) 633-5127
NPI assigned
May 14, 2014
Last updated
Nov 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

777 Hemlock St
MSC 140
Macon, GA 31201-2102

Mailing address

777 Hemlock St
MSC 140
Macon, GA 31201-2102
Phone (478) 633-8115

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address justin.vaughan@direct.myteamcare.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200713000958 TX Practitioner - General Surgery 5496075681 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Arkansas College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4102 24TH St
Suite 508
Lubbock, TX 79410-1805
Phone (806) 743-1810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.52 of 100Reported as apm
Quality
87.98
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Aug 1, 2020 Accepting new patients
Texas Tech University Health Sciences Center Lubbock Current Accepting new patients
Texas Tech University Health Sciences Center Lubbock CurrentSince Aug 1, 2020 Accepting new patients
Texas Tech University Health Sciences Center Lubbock Past Accepting new patients
Lubbock County Hospital District Past Accepting new patients

Locations

3601 4th St
Lubbock, TX 79430
Phone (806) 743-1000

4102 24th St
Ste 508
Lubbock, TX 79410
Phone (806) 725-5830

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636416000000",
    "number": "1083025886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 HEMLOCK ST",
            "address_2": "MSC 140",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012102",
            "telephone_number": "478-633-8115",
            "fax_number": "478-633-5127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HEMLOCK ST",
            "address_2": "MSC 140",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012102",
            "telephone_number": "478-633-8115",
            "fax_number": "478-633-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "JUSTIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-14",
        "last_updated": "2021-11-09",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "justin.vaughan@direct.myteamcare.com",
            "affiliation": "N",
            "address_1": "3601 4th St",
            "city": "Lubbock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "794300002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.