Justin A Otis, DNP, APRN-CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4012118 Issued in KY

Practice address

11723 Wells Creek Pkwy Apt 1217
Jacksonville, FL 32256-1981

Phone

(904) 240-2841

NPI assigned

Jul 31, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Greater Louisville Anesthesia Services, PLLC 10 clinicians

Community Medical Associates Inc 1,368 clinicians

Apollo Medical Group of Jeffersonville LLC 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Lagrange Hospital, La Grange, KY, CCN 180138
• Norton-King'S Daughters' Health Hospital, Madison, IN, CCN 150069

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Apollo Medical Group of Jeffersonville LLC

  • Anesthesiology Physician
  • Jeffersonville, IN
  • NPI 1124607205

  IN, Single Specialty

  Medicare reassignment Care Compare group NPD
• Community Medical Associates, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1588614994

  IN, Single Specialty

  Medicare reassignment Care Compare group NPD
• Greater Louisville Anesthesia Services, PLLC

  • Anesthesiology Physician
  • Lagrange, KY
  • NPI 1326126681

  KY, Single Specialty

  Medicare reassignment Care Compare group NPD
• Community Medical Associates, Inc.

  • Multi-Specialty Clinic/Center
  • Louisville, KY
  • NPI 1306983762
  Care Compare group
• Community Medical Associates, Inc.

  • Anesthesiology Physician
  • Louisville, KY
  • NPI 1194451179

  Nurse Anesthetist, Certified Registered

  NPD
• Community Medical Associates, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1881192409
  NPD
• Community Medical Associates, Inc.

  • Neurological Surgery Physician
  • Louisville, KY
  • NPI 1922288760

  Single Specialty

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Healthcare System, Inc.

  • General Acute Care Hospital
  • La Grange, KY
  • NPI 1306925540

  Hospital

  Care Compare affiliation
• Norton - Kings Daughters Health Inc

  • Clinical Medical Laboratory
  • Madison, IN
  • NPI 1497024426

  Hospital

  Care Compare affiliation
• Norton - Kings Daughters Health Inc

  • Land Ambulance
  • Madison, IN
  • NPI 1891855045

  Hospital

  Care Compare affiliation
• Norton - Kings Daughters Health, Inc

  • General Acute Care Hospital
  • Madison, IN
  • NPI 1518916048

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1245911262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 JUDGE CARDEN BLVD",
            "city": "CRESTWOOD",
            "state": "KY",
            "postal_code": "400147805",
            "telephone_number": "904-240-2841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11723 WELLS CREEK PKWY APT 1217",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561981",
            "telephone_number": "904-240-2841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTIS",
        "first_name": "JUSTIN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN-CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-31",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9356204",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "4012118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Otaku Collect LLC
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• Christa Marie Otero, RCSWI
• Carlos Acosta Oteyza, M.D.
• Eman Othman, BDS, MS, CAGS
• Anna Marie Otoole
• Gabrielle Otremba
• Amber Lynn Ott, APRN
• Megan Marie Ott
• Ottawahills Optical Inc

• All providers in Jacksonville, FL
• Certified Registered Nurse Anesthetist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.