NPIMap

Individual provider Active NPI

Johnathon David Justice, M.D.

  • Family Medicine Physician
  • Thorp, WI
National Provider Identifier
1437419801
Registry record updated Jul 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
64039 Issued in WI
Practice address
704 S Clark St
Thorp, WI 54771-7624
Phone
(715) 669-7279
NPI assigned
May 20, 2012
Last updated
Jul 7, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 64039 WI Primary

Addresses

Primary practice location

704 S Clark St
Thorp, WI 54771-7624

Mailing address

704 S Clark St
Thorp, WI 54771-7624
Phone (715) 669-7279

Other identifiers 1

IdentifierTypeStateIssuer
64039OtherWIWI STATE LIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150716001280 WI Practitioner - Family Practice 9931331600 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sport and Spine Clinic LPGroup PAC ID 9830008846, shared by 2 NPIs, 26 clinicians

Practice addresses (Care Compare)

1120 Pine St
Stanley, WI 54768-1297
Phone (715) 644-5530

704 S Clark St
Thorp, WI 54771-7624
Phone (715) 669-7279

PO Box
Suite 297
Greenwood, WI 54437

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Stanley Hospital & Clinics, Inc. CurrentSince Jun 30, 2015 Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc. Family Medicine CurrentSince Dec 7, 2021 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Family Medicine CurrentSince Jan 17, 2026 Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc Family Medicine Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

135 S Gibson St
Medford, WI 54451
Phone (715) 748-8100

143 S Gibson St
Medford, WI 54451
Phone (715) 748-2121

6 Johnson St
Owen, WI 54460
Phone (715) 229-2177

1120 Pine St
Stanley, WI 54768
Phone (715) 644-5530

704 S Clark St
Thorp, WI 54771
Phone (715) 669-5536

Interoperability endpoints

  • Direct secure messaging: jjustice169474@direct.aspirus.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1337472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436227200000",
    "number": "1437419801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 S CLARK ST",
            "city": "THORP",
            "state": "WI",
            "postal_code": "547717624",
            "telephone_number": "715-669-7279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S CLARK ST",
            "city": "THORP",
            "state": "WI",
            "postal_code": "547717624",
            "telephone_number": "715-669-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSTICE",
        "first_name": "JOHNATHON",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-20",
        "last_updated": "2015-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "64039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI STATE LIC",
            "identifier": "64039",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thorp, WI

Sources for this page

Verify at the official NPI Registry.