Individual provider Active NPI

Justin Dean Judkins

  • Physician Assistant
  • Pocatello, ID
National Provider Identifier
1316677594
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-2579 Issued in ID
Practice address
777 Hospital Way
Pocatello, ID 83201-5175
Phone
(208) 239-1000
NPI assigned
Jun 12, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-2579 ID Primary

Addresses

Primary practice location

777 Hospital Way
Pocatello, ID 83201-5175

Mailing address

921 S 8TH Ave Stop 8253
Pocatello, ID 83209-0002
Phone (208) 282-4726

Other practice location 1

921 S 8th Ave Stop 8253
Pocatello, ID 83209-0002
Phone (208) 282-4726

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231212003892 ID Practitioner - Physician Assistant 9234588567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

777 Hospital Way
Pocatello, ID 83201-5175

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Hospital LLC Current Accepting new patients
Pocatello Health Services, LLC CurrentSince Nov 6, 2023 Accepting new patients

Locations

777 Hospital Way
Ste 204
Pocatello, ID 83201
Phone (208) 239-2110

777 Hospital Way
Ste 201
Pocatello, ID 83201
Phone (208) 239-2260

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

Interoperability endpoints

  • Direct secure messaging: jjudkins439063@ahs.direct-ci.com

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1654992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1316677594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 S 8TH AVE STOP 8253",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090002",
            "telephone_number": "208-282-4726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 S 8th Ave Stop 8253",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832090002",
            "country_code": "US",
            "telephone_number": "208-282-4726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUDKINS",
        "first_name": "JUSTIN",
        "middle_name": "DEAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-12",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.