NPIMap

Individual provider Active NPI

Justin E. Hugo, M.D.

  • Family Medicine Physician
  • Fenton, MO
National Provider Identifier
1104826098
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2004002167 Issued in MO
Practice address
714 Gravois Rd
Suite 210
Fenton, MO 63026-7727
Phone
(314) 543-5230
Fax
(314) 543-5280
NPI assigned
Jul 21, 2005
Last updated
Apr 7, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2004002167 MO Primary

Addresses

Primary practice location

714 Gravois Rd
Suite 210
Fenton, MO 63026-7727

Mailing address

714 Gravois Rd
Suite 210
Fenton, MO 63026-7727
Phone (314) 543-5230

Other identifiers 1

IdentifierTypeStateIssuer
208987800MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20040927000346 MO Practitioner - Family Practice 5991774002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Multispecialty Group IncGroup PAC ID 1658365572, 118 clinicians

Practice addresses (Care Compare)

714 Gravois Rd
Suite 210
Fenton, MO 63026-7723
Phone (636) 660-9850

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2004002167MOMDFamily Medicine Physician

Interoperability endpoints

  • Direct secure messaging: justin.hugo.p1@direct.essehealth.nextgenshare.com

Organizations & group practices 1

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": "1121904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270598400000",
    "number": "1104826098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "address_2": "SUITE 210",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267727",
            "telephone_number": "314-543-5230",
            "fax_number": "314-543-5280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 GRAVOIS RD",
            "address_2": "SUITE 210",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630267727",
            "telephone_number": "314-543-5230",
            "fax_number": "314-543-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUGO",
        "first_name": "JUSTIN",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-21",
        "last_updated": "2010-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2004002167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208987800",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.