Individual provider Active NPI

Justin Lee Marlar, MD

  • Emergency Medicine Physician
  • Jackson, TN
National Provider Identifier
1609165760
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
49097 Issued in TN
Practice address
294 Summar Dr
Jackson, TN 38301-3915
Phone
(731) 423-1932
Fax
(731) 410-0367
NPI assigned
Mar 29, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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
Emergency Medicine Physician 207P00000X 49097 TN Primary

Addresses

Primary practice location

294 Summar Dr
Jackson, TN 38301-3915

Mailing address

294 Summar Dr
Jackson, TN 38301-3915
Phone (731) 423-1932

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS, AR3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20121017000474 TN Practitioner - Family PracticePractitioner - Emergency Medicine 0143470799 Reassigns benefits to 5 organizations
I20180522002033 MS Practitioner - Family PracticePractitioner - Emergency Medicine 0143470799 Reassigns benefits to 1 organization
I20181121001008 AR Practitioner - Family Practice 0143470799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Tennessee, HSC, College of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

4800 E Johnson Ave
Jonesboro, AR 72405-8413
Phone (870) 936-1000

7601 Southcrest Pkwy
Southaven, MS 38671-4739
Phone (662) 772-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
WT University Medical Associates Inc Current Accepting new patients
Concord Medical Group PLLC Emergency Medicine CurrentSince Oct 31, 2015 Accepting new patients
University of Tennessee CurrentSince Apr 1, 2014 Accepting new patients
Eagle Creek Emergency Group, PC Emergency Medicine CurrentSince Mar 10, 2018 Accepting new patients
University of Tennessee CurrentSince Apr 1, 2014 Accepting new patients
Concord Medical Group of Texas PLLC Emergency Medicine CurrentSince Oct 31, 2015 Accepting new patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Sep 1, 2017 Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Aug 10, 2015 Accepting new patients
Emergency Coverage Services, PC Past Accepting new patients
Decatur County General Hospital Past Accepting new patients

Locations

4800 E Johnson Ave
Jonesboro, AR 72405
Phone (870) 732-2100

7601 Southcrest Pkwy
Southaven, MS 38671
Phone (662) 349-4000

5001 E Main St
Erin, TN 37061
Phone (336) 944-6420

294 Summar Dr
Jackson, TN 38301
Phone (731) 423-1932

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

1607 S Locust Ave
Lawrenceburg, TN 38464
Phone (731) 287-2244

301 Tyson Ave
Paris, TN 38242
Phone (731) 642-1220

969 Tennessee Ave S
Parsons, TN 38363
Phone (731) 660-8755

Interoperability endpoints

  • Direct secure messaging: jmarlar155697@direct.bmhcc.org

Organizations & group practices 10

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 1

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": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1609165760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "294 SUMMAR DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013915",
            "telephone_number": "731-423-1932",
            "fax_number": "731-410-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "294 SUMMAR DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013915",
            "telephone_number": "731-423-1932",
            "fax_number": "731-410-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARLAR",
        "first_name": "JUSTIN",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-29",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "49097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.