Justin Banghart, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1164974 Issued in NU

Practice address

21St MDG 559 Vincent St
Pafb, CO 80914-1540

Phone

(719) 556-5898

NPI assigned

Dec 12, 2019

Last updated

Jun 30, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1346888088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 VINVENT ST",
            "city": "PETERSON SPACE FORCE BASE",
            "state": "CO",
            "postal_code": "80914",
            "telephone_number": "719-556-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21ST MDG 559 VINCENT ST",
            "city": "PAFB",
            "state": "CO",
            "postal_code": "809141540",
            "telephone_number": "719-556-5898"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7219 N Litchfield Rd",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853091529",
            "country_code": "US",
            "telephone_number": "623-856-6127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANGHART",
        "first_name": "JUSTIN",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-12",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": "1164974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joel Timothy Foster, PH.D.
• Samantha Murphy, PT, DPT

• Physician Assistant in Pafb, CO
• Providers in Pafb, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.