Individual provider Active NPI

Justin Garland Thomas, D.O.

  • Family Medicine Physician
  • Punta Gorda, FL
National Provider Identifier
1205990959
Registry record updated Feb 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102202107 Issued in VA
Practice address
3928 Crooked Island Dr
Punta Gorda, FL 33950-8128
Phone
(909) 964-4109
NPI assigned
Dec 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Military Health Care Provider 171000000X
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 0102202107 VA Primary

Addresses

Primary practice location

3928 Crooked Island Dr
Punta Gorda, FL 33950-8128

Mailing address

3928 Crooked Island Dr
Punta Gorda, FL 33950-8128
Phone (909) 964-4109

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20151209002836 VA Order and Referring Only - Family PracticePractitioner - Family Practice 7517268899

National Provider Directory

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423699200000",
    "number": "1205990959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3928 CROOKED ISLAND DR",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339508128",
            "telephone_number": "909-964-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3928 CROOKED ISLAND DR",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339508128",
            "telephone_number": "909-964-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "JUSTIN",
        "middle_name": "GARLAND",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2015-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102202107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Punta Gorda, FL

Sources for this page

Verify at the official NPI Registry.