Active NPI
Justin Davis
- Plastic and Reconstructive Surgery Physician
- Springfield, IL
National Provider Identifier
1437714375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- 125.077838
- Practice address
- 747 N Rutledge St
Springfield, IL 62702-6700 - Phone
- (217) 545-6112
- NPI assigned
- May 6, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 125.077838 | IL | Primary |
Addresses
Primary practice location
747 N Rutledge St
Springfield, IL 62702-6700
Mailing address
PO Box 19653
Springfield, IL 62794-9653
Phone (217) 545-2588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200716000674 | WI | Order and Referring Only - General Surgery | 8820412489 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.077838 | IL | MD | Plastic and Reconstructive Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624752000000",
"number": "1437714375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19653",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627949653",
"telephone_number": "217-545-2588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "747 N RUTLEDGE ST",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627026700",
"telephone_number": "217-545-6112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-06",
"last_updated": "2021-06-27",
"certification_date": "2021-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "IL",
"license": "125.077838",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.