Individual provider Active NPI

Justin T John, NP

  • Family Nurse Practitioner
  • Liverpool, NY
National Provider Identifier
1104529890
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F350077 Issued in NY
Practice address
5100 W Taft Rd
Liverpool, NY 13088-3807
Phone
(315) 452-2828
Fax
(315) 744-1950
NPI assigned
Mar 23, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F350077 NY Primary

Addresses

Primary practice location

5100 W Taft Rd
Liverpool, NY 13088-3807

Mailing address

405 Mallard Dr
Camillus, NY 13031-2097
Phone (315) 546-4416

Other practice location 1

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-6253

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20230512002009 NY Practitioner - Nurse Practitioner 4284090481 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

301 Prospect Ave
Syracuse, NY 13203-1807
Phone (315) 448-5111

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
  • St Joseph'S Hospital Health Center Hospital, Syracuse, NY, CCN 330140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F350077NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Suny Health Science Center at Syracuse Family CurrentSince Dec 5, 2024 Accepting new patients
St. Joseph'S Pathology, PC Current Accepting new patients
St Josephs Hospital Health Center CurrentSince Apr 11, 2023 Accepting new patients
Suny Health Science Center at Syracuse CurrentSince Dec 5, 2024 Accepting new patients
North Medical PC Current Accepting new patients
St Josephs Medical PC CurrentSince May 6, 2023 Accepting new patients

Locations

7209 Buckley Rd
Liverpool, NY 13088
Phone (315) 299-5451

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

725 E Adams St
Syracuse, NY 13210
Phone (315) 464-4357

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

301 Prospect Ave
Ste 706
Syracuse, NY 13203
Phone (315) 703-5200

Interoperability endpoints

  • Direct secure messaging: jjohn2383991@direct.trinity-health.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1679529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1104529890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 MALLARD DR",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312097",
            "telephone_number": "315-546-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2828",
            "fax_number": "315-744-1950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132031807",
            "country_code": "US",
            "telephone_number": "315-448-6253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHN",
        "first_name": "JUSTIN",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-23",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F350077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liverpool, NY

Sources for this page

Verify at the official NPI Registry.