Justin Fojo, PA-C
Individual provider Active NPI Physician Assistant · Heathrow, FL
NPI 1205447372 · NPPES record last updated Aug 26, 2024
Key facts
- NPI
- 1205447372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9113226 (FL)
- Practice address
- 120 International Pkwy Ste 240
Heathrow, FL 32746-5033 - Phone
- (407) 333-4200
- NPI assigned
- Aug 12, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Leavitt Medical Associates of Florida Inc
Practice addresses (Care Compare)
1410 W Broadway St
Suite 205
Oviedo, FL 32765-6472
Phone (407) 359-2100
1503 Buenos Aires Blvd
Suite 100
The Villages, FL 32159-6825
Phone (352) 753-2812
1801 Lee Rd
Suite 115
Winter Park, FL 32789-2163
Phone (407) 647-7300
818 N Woodland Blvd
Deland, FL 32720-2709
Phone (386) 738-8000
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210217000379 | FL | Practitioner - Physician Assistant | 5193130573 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles (3 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Leavitt Medical Associates of Florida Inc | Dermatology | Current |
Accepting new patients |
| Leavitt Medical Associates of Florida Inc | Dermatology | Current |
Accepting new patients |
| Leavitt Medical Associates of Florida Inc | Dermatology | Past | Accepting new patients |
Locations
2915 Lakeview Dr
Ste 2021
Fern Park, FL 32730
Phone (407) 788-8900
120 International Pkwy
Ste 240
Lake Mary, FL 32746
Phone (407) 333-4200
151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293
1507 Park Center Dr
Ste 1D
Orlando, FL 32835
Phone (407) 445-9445
1410 W Broadway St
Ste 205
Oviedo, FL 32765
Phone (407) 359-2100
1503 Buenos Aires Blvd
Ste 100
The Villages, FL 32159
Phone (352) 753-2812
1801 Lee Rd
Ste 115
Winter Park, FL 32789
Phone (407) 644-1500
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9113226 | FL | Yes |
Addresses
Primary practice location
120 International Pkwy Ste 240
Heathrow, FL 32746-5033
Mailing address
170 Columbus Cir
Longwood, FL 32750-6521
Other providers in Heathrow, FL
- Latanya Earnest
- Sarah Eiseman
- John Ender
- Tracy Ender
- Fly Wheel Center FL LLC
- Stacey Fournier
- Ashley Galvin
- Kaisen Garcia
- Lori A Garrett
- Shannon Gfell
All providers in Heathrow, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.