NPIMap

Individual provider Active NPI

Justin Taylor, PA-C

  • Physician Assistant
  • Lebanon, OH
National Provider Identifier
1932659620
Registry record updated Oct 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.004858RX Issued in OH
Practice address
1470 N Broadway St
Suite 100
Lebanon, OH 45036-1744
Phone
(513) 932-1936
Fax
(513) 932-3105
NPI assigned
Oct 6, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.004858RX OH Primary

Addresses

Primary practice location

1470 N Broadway St
Suite 100
Lebanon, OH 45036-1744

Mailing address

1470 N Broadway St
Suite 100
Lebanon, OH 45036-1744
Phone (513) 932-1936

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.004858RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc Past Accepting new patients
Midwest Ohio Five Medical Group, PLLC Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475712000000",
    "number": "1932659620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470 N BROADWAY ST",
            "address_2": "SUITE 100",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450361744",
            "telephone_number": "513-932-1936",
            "fax_number": "513-932-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1470 N BROADWAY ST",
            "address_2": "SUITE 100",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450361744",
            "telephone_number": "513-932-1936",
            "fax_number": "513-932-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "JUSTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-06",
        "last_updated": "2016-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004858RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.