Justin Jeremiah Chin, D.O.
Individual provider Active NPI Sports Medicine (Family Medicine) Physician · Offutt Afb, NE
NPI 1154825552 · NPPES record last updated Jun 28, 2024
Key facts
- NPI
- 1154825552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- License
- 201902726 (NC)
- Practice address
- 2501 Capehart Rd
Offutt Afb, NE 68113-1043 - Phone
- (402) 232-2273
- NPI assigned
- Mar 20, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200507000536 | FL | Order and Referring Only - Family Practice |
2062843071 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201902726 | NC | MD | Sports Medicine (Family Medicine) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 201902726 | NC | Yes |
| Family Medicine Physician | 207Q00000X | 201902726 | NC |
Addresses
Primary practice location
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Mailing address
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Other providers in Offutt Afb, NE
- David Carlsen
- Madeleine Carlsen
- Chad Bryan Carter
- Jocelin P Cartier
- Tawnee Marie Chandler
- Coleman Kord Christensen
- Andrew Joseph Colburn
- Jessica Manton Cole
- Christian Fletcher Cooper
- Shauna G Crim
All providers in Offutt Afb, NE · Sports Medicine (Family Medicine) Physician in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.