Active NPI
Justin D Wasdin, PA-C
- Physician Assistant
- Port St Lucie, FL
National Provider Identifier
1245777929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9110163
- Practice address
- 10080 SW Innovation Way Ste 102
Port St Lucie, FL 34987-2129 - Phone
- (772) 344-3811
- Fax
- (772) 283-4919
- NPI assigned
- Jan 19, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9110163 | FL | Primary |
Addresses
Primary practice location
10080 SW Innovation Way Ste 102
Port St Lucie, FL 34987-2129
Mailing address
PO Box 417
Stuart, FL 34995-0417
Phone (772) 223-2832
Other practice location 1
509 SE Riverside Dr
Suite 305
Stuart, FL 34994-2579
Phone (772) 221-2003
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019931500 | Medicaid | FL | |
| J2ZXG | Other | FL | FLORIDA BLUE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jwasdin49321@direct.martinhealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
200 SE Hospital Ave
Stuart, FL 34994-2346
Phone (772) 223-5665
Hospital & facility affiliations
- Cleveland Clinic Martin North Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.26 of 100
- Quality
- 80.2
- Promoting interoperability
- 99.24
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9110163 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Euclid Hospital Cleveland Clinic Health System | Current | Accepting new patients | |
| Martin Memorial Physician Corporation, Inc | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Interoperability endpoints
- jwasdin2496301@direct.ccf.org
Organizations & group practices 3
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.
-
- General Acute Care Hospital
- Stuart, FL
- NPI 1194790055
-
- General Acute Care Hospital
- Euclid, OH
- NPI 1457403016
-
- Community/Retail Pharmacy
- Port St Lucie, FL
- NPI 1407365513
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Stuart, FL
- NPI 1194790055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1245777929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 417",
"city": "STUART",
"state": "FL",
"postal_code": "349950417",
"telephone_number": "772-223-2832",
"fax_number": "772-223-5646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10080 SW INNOVATION WAY STE 102",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349872129",
"telephone_number": "772-344-3811",
"fax_number": "772-283-4919"
}
],
"practiceLocations": [
{
"address_1": "509 SE Riverside Dr",
"address_2": "SUITE 305",
"address_purpose": "LOCATION",
"city": "Stuart",
"state": "FL",
"postal_code": "349942579",
"country_code": "US",
"telephone_number": "772-221-2003",
"fax_number": "772-286-0018",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WASDIN",
"first_name": "JUSTIN",
"middle_name": "D",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-01-19",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9110163",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019931500",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA BLUE",
"identifier": "J2ZXG",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jwasdin49321@direct.martinhealth.org",
"affiliation": "N",
"address_1": "10080 SW Innovation Way Ste 102",
"city": "Port St Lucie",
"state": "FL",
"country_code": "US",
"postal_code": "349872129",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.