Individual provider Active NPI

Justin Lawrence Lockman, M.D.

  • Pediatric Critical Care Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1114065497
Registry record updated Dec 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
MD442301 Issued in PA
Practice address
3401 Civic Center Blvd Ste 9329
Philadelphia, PA 19104-4319
Phone
(215) 590-1858
Fax
(215) 590-1415
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Anesthesiology Physician 207LP3000X MD442301 PA
Pediatric Critical Care Medicine Physician 2080P0203X MD442301 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd Ste 9329
Philadelphia, PA 19104-4319

Mailing address

3401 Civic Center Blvd Ste 9329
Philadelphia, PA 19104-4319
Phone (215) 590-1858

Other practice location 1

550 S Goddard Blvd
King Of Prussia, PA 19406-2922
Phone (610) 337-3232

Other identifiers 2

IdentifierTypeStateIssuer
221556EMDOtherPAMEDICARE PTAN
1025929790001MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110727000259 PA Practitioner - Pediatric MedicinePractitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 9638347156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Anesthesiology, Critical Care (Intensivists)
Education
Vanderbilt University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3401 Civic Ctr Blvd
Philadelphia, PA 19104-4319
Phone (215) 590-1858

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD442301PAMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Anesthesiology Associates, LTD Pediatric Anesthesiology CurrentSince Jul 1, 2011 Accepting new patients
Children'S Anesthesiology Associates, LTD Pediatric Critical Care Medicine CurrentSince Jul 1, 2011 Accepting new patients
Children'S Anesthesiology Associates, LTD Pediatric Anesthesiology Current Accepting new patients
Childrens Hospital of Philadelphia Past Accepting new patients

Locations

550 S Goddard Blvd
King of Prussia, PA 19406
Phone (610) 337-3232

100 E Penn Sq
Bldg 9TH
Philadelphia, PA 19107
Phone (267) 425-9538

3401 Civic Center Blvd
Ste 9329
Philadelphia, PA 19104
Phone (267) 425-9300

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

Organizations & group practices 4

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": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1114065497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD STE 9329",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1858",
            "fax_number": "267-425-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD STE 9329",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-1858",
            "fax_number": "215-590-1415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 S Goddard Blvd",
            "address_purpose": "LOCATION",
            "city": "King Of Prussia",
            "state": "PA",
            "postal_code": "194062922",
            "country_code": "US",
            "telephone_number": "610-337-3232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOCKMAN",
        "first_name": "JUSTIN",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "PA",
            "license": "MD442301",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "PA",
            "license": "MD442301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "221556EMD",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025929790001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.