NPIMap

Individual provider Active NPI

Justin P Harrell, M.D.

  • Family Medicine Physician
  • Gainesville, FL
National Provider Identifier
1881214815
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME169164 Issued in FL
Practice address
4343 W Newberry Rd
Gainesville, FL 32607-2817
Phone
(352) 372-8202
Fax
(352) 375-6888
NPI assigned
Apr 20, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME169164 FL
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X ME169164 FL Primary

Addresses

Primary practice location

4343 W Newberry Rd
Gainesville, FL 32607-2817

Mailing address

4881 NW 8TH Ave
Suite 2
Gainesville, FL 32605-4582
Phone (352) 416-1082

Other identifiers 1

IdentifierTypeStateIssuer
123865800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20240920002366 FL Practitioner - Internal MedicinePractitioner - Pediatric Medicine 4082155742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Other, 2020
Medicare assignment
May accept Medicare assignment
Group practices
Simedhealth LLCGroup PAC ID 6608137054, 89 clinicians
Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

4343 Newberry Rd
Suite 11
Gainesville, FL 32607-2825
Phone (352) 416-1082

4343 W Newberry Rd
Gainesville, FL 32607-2817
Phone (352) 416-1082

4343 W Newberry Rd
Suite 10
Gainesville, FL 32607-2825
Phone (352) 416-1082

PO Box
Suite 1099
Melrose, FL 32666-1099

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME169164FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Simed Health LLC CurrentSince Nov 1, 2024 Accepting new patients
Simedhealth LLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

4343 Newberry Rd
Gainesville, FL 32607
Phone (352) 224-2200

4881 NW 8th Ave
Ste 2
Gainesville, FL 32605
Phone (352) 373-6338

Organizations & group practices 3

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 12

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": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1881214815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 NW 8TH AVE",
            "address_2": "SUITE 2",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054582",
            "telephone_number": "352-416-1082",
            "fax_number": "352-373-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 W NEWBERRY RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326072817",
            "telephone_number": "352-372-8202",
            "fax_number": "352-375-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRELL",
        "first_name": "JUSTIN",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-20",
        "last_updated": "2024-10-18",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME169164",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME169164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123865800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.