Edmundo Samuel Justino, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

60368 Issued in AZ

Practice address

802 Ainsworth Dr Ste a
Prescott, AZ 86301-1623

Phone

(928) 771-5548

Fax

(928) 771-5549

NPI assigned

Dec 1, 2006

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 4

Medicare fee-for-service enrollment

Enrolled in AZ

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

Gastroenterology

Education

University of Texas Medical Branch at Galveston, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Yavapai Regional Medical Center Physician Care LLCGroup PAC ID 5294898987, 123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012
• St Josephs Hospital and Medical Center Hospital, Phoenix, AZ, CCN 030024

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Yavapai Regional Medical Center Physician Care LLC

  • Cardiovascular Disease Physician
  • Prescott, AZ
  • NPI 1255582003
  Medicare reassignment Care Compare group NPD
• Yavapai Regional Medical Center Physician Care LLC

  • Cardiovascular Disease Physician
  • Prescott, AZ
  • NPI 1528394830
  NPD
• Prescott Gastroenterology

  • Gastroenterology Physician
  • Prescott, AZ
  • NPI 1720110984
  NPD (past)

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

• Dignity Health

  • Emergency Care Clinic/Center
  • Litchfield Park, AZ
  • NPI 1265065445

  Hospital

  Care Compare affiliation
• Dignity Health

  • Emergency Care Clinic/Center
  • Glendale, AZ
  • NPI 1609408665

  Hospital

  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1982733655
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1992131734
  Care Compare affiliation
• Yavapai Community Hospital Association

  • General Acute Care Hospital
  • Prescott, AZ
  • NPI 1902897820
  Care Compare affiliation

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1720156136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10880",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040880",
            "telephone_number": "602-406-4786",
            "fax_number": "916-636-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 AINSWORTH DR STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011623",
            "telephone_number": "928-771-5548",
            "fax_number": "928-771-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSTINO",
        "first_name": "EDMUNDO",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ND",
            "license": "11931",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "60368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "215032801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "TXB107550",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "60368",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007145",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph P. Griffin, MD, PC
• Colin R Joseph, PH.D.
• Jason Lawrence Joshua
• Journey Within LLC
• Judah D Pifer MD, PLLC
• Kadrmas Chiropractic, P.C.
• Patrick Donald Kadrmas, DC
• Martti Ellis Kahkonen, M.D.
• Deni Kahn, L.M.T.
• Amy Kallio, PA

• Gastroenterology Physician in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Gastroenterology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; 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.