Individual provider Active NPI

Justine Lee Hudson, PA-C

  • Physician Assistant
  • San Antonio, TX
National Provider Identifier
1104370543
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10721 Issued in TX
Practice address
1055 Ada St
San Antonio, TX 78223-1703
Phone
(210) 358-5515
Fax
(210) 358-5530
NPI assigned
Aug 13, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10721 TX Primary

Addresses

Primary practice location

1055 Ada St
San Antonio, TX 78223-1703

Mailing address

PO Box 87
San Antonio, TX 78291-0087
Phone (210) 358-9172

Other names 1

  • Ms. Justine Lee Hatton Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170920002647 TX Practitioner - Physician Assistant 5799059382 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA10721TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Management Specialists PastSince Feb 7, 2021 Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1471046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1104370543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782910087",
            "telephone_number": "210-358-9172",
            "fax_number": "210-358-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 ADA ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782231703",
            "telephone_number": "210-358-5515",
            "fax_number": "210-358-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "JUSTINE",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTINE",
            "last_name": "HATTON",
            "middle_name": "LEE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.