NPIMap

Individual provider Active NPI

Matthew L Justus, PA-C

  • Physician Assistant
  • Glade Spring, VA
National Provider Identifier
1821033895
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110001912 Issued in VA
Practice address
202 Town Square St.
Glade Spring, VA 24340
Phone
(276) 429-1410
Fax
(276) 783-2879
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 0110001912 VA
Physician Assistant 363A00000X 01170 WV
Physician Assistant 363A00000X 0110001912 VA Primary

Addresses

Primary practice location

202 Town Square St.
Glade Spring, VA 24340

Mailing address

16000 Johnston Memorial Dr
Abingdon, VA 24211-7659
Phone (276) 258-4050

Other identifiers 3

IdentifierTypeStateIssuer
Q007384MedicaidTN
P01198022OtherVARR MEDICARE
1821033895MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20070308000535 VA Practitioner - Physician Assistant 0749201978 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

202 Town Square St
Glade Spring, VA 24340-2924
Phone (276) 429-1410

Hospital & facility affiliations

  • Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053
  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
  • Smyth County Community Hospital Hospital, Marion, VA, CCN 490038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110001912VAMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johnston Memorial Hospital Past Accepting new patients
JMH Emergency Physicians LLC Past Accepting new patients

Organizations & group practices 4

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 5

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1821033895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-258-4050",
            "fax_number": "276-258-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 TOWN SQUARE ST.",
            "city": "GLADE SPRING",
            "state": "VA",
            "postal_code": "24340",
            "telephone_number": "276-429-1410",
            "fax_number": "276-783-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUSTUS",
        "first_name": "MATTHEW",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "VA",
            "license": "0110001912",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "01170",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q007384",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01198022",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821033895",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glade Spring, VA

Sources for this page

Verify at the official NPI Registry.