Justin P Kittredge, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME149949 Issued in FL

Practice address

701 W Plymouth Ave
Deland, FL 32720-3236

Phone

(386) 943-4522

Fax

(833) 549-5578

NPI assigned

Jul 12, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Albany Medical College of Union University, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Medicine Professionals PAGroup PAC ID 0446244362, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363
• AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Emergency Medicine Professionals PA

  • Emergency Medicine Physician
  • Deland, FL
  • NPI 1205880853
  Medicare reassignment Care Compare group NPD

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

• Adventhealth Palm Coast Parkway Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1861102345
  Care Compare affiliation
• Memorial Hospital Flagler Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  Care Compare affiliation

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

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1346726452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9430",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321209430",
            "telephone_number": "386-274-7800",
            "fax_number": "833-549-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W PLYMOUTH AVE",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327203236",
            "telephone_number": "386-943-4522",
            "fax_number": "833-549-5578"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 Kuhl Ave # Mp31",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328062008",
            "country_code": "US",
            "telephone_number": "407-841-5133",
            "fax_number": "407-237-6313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KITTREDGE",
        "first_name": "JUSTIN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2021-07-07",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "TRN27655",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME149949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110477800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "OMCPJ",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cescille C Kerr, PMHNP-BC
• Julie Kersey
• Ebram Khela
• Iliya Khramov, M.D.
• Susan Kimeria
• Kaylin Mae Kluvi, CSTFA
• Alissa Knight, LCSW
• Edward Vincent Kornuszko, PSY.D.
• Andrew J Kovachy, ATC, LAT
• Wesley Kramer, MD

• Emergency Medicine Physician in Deland, FL
• Providers in Deland, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2021; 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.

Verify at the official NPI Registry.