Justin Hastings, DDS, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

D-4845OS Issued in ID

Practice address

3003 W Main St Ste 130
Boise, ID 83702-2026

Phone

(208) 342-7610

Fax

(208) 344-1799

NPI assigned

Feb 28, 2011

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 31, 2017 through Jul 31, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Whitewater Oral Surgery Group PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1104248053
  NPD (past)

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523836800000",
    "number": "1831496843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 W MAIN ST STE 130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837022026",
            "telephone_number": "208-342-7610",
            "fax_number": "208-344-1799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 W MAIN ST STE 130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837022026",
            "telephone_number": "208-342-7610",
            "fax_number": "208-344-1799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASTINGS",
        "first_name": "JUSTIN",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-02-28",
        "last_updated": "2018-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "ID",
            "license": "D-4845OS",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "ID",
            "license": "M-13732",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104248053",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David E Hassinger, MD
• Sean Hassinger, MD
• Brittany Marie Hassis, LPC
• Angela Hastings, BCMT
• Jon Riley Hastings, DDS
• Aimee Lynn Hastriter, DNP, CPNP
• Christine E. Hatab, PT
• Kyle Hiromi Hatanaka, LAC
• Matthew Hatch
• Lori Hatcher

• Oral & Maxillofacial Surgery (D.M.D.) in Boise, ID
• Providers in Boise, ID by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.