S Justin Michael Eagleston
Individual provider Active NPI Surgery Physician · Ontario, OH
NPI 1942663554 · NPPES record last updated Oct 19, 2023
Key facts
- NPI
- 1942663554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 35.148903 (OH)
- Practice address
- 715 Richland Mall
Ontario, OH 44906-3802 - Phone
- (567) 307-7854
- Fax
- (567) 307-7855
- NPI assigned
- Mar 31, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 25
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Central Ohio Family Care Center Inc
Galion Community Hospital
Practice addresses (Care Compare)
269 Portland Way S
Galion, OH 44833-2312
Phone (419) 468-4841
2981 W 4TH St
Ontario, OH 44906-1267
Phone (419) 468-0505
629 N Sandusky Ave
Bucyrus, OH 44820-1821
Phone (419) 562-4677
715 Richland Mall
Ontario, OH 44906-3802
Phone (567) 307-7557
Hospital & facility affiliations
- Avita Ontario
- Bucyrus Community Hospital
- Galion Community Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 1-10 |
| Hernia repair (minimally invasive) | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 28 |
| Melanoma (skin cancer) excision | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220810001893 | NC | Practitioner - General Surgery | 1658754593 | Reassigns benefits to 2 organizations |
| I20230821001802 | OH | Practitioner - General Surgery | 1658754593 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.148903 | OH | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolinas Medical Center | Current |
Accepting new patients | |
| Carolinas Physicians Network Inc | Current | Accepting new patients | |
| Carolinas Physicians Network Inc | Current |
Accepting new patients | |
| Carolinas Medical Center | Current | Accepting new patients | |
| Carolinas Medical Center | Current |
Accepting new patients | |
| Carolinas Physicians Network Inc | Surgery | Current |
Accepting new patients |
| Bucyrus Community Hospital LLC | Past | Accepting new patients |
Locations
1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791
2608 E 7th St
Charlotte, NC 28204
Phone (704) 344-9034
2630 E 7th St
Charlotte, NC 28204
Phone (704) 355-9484
Interoperability endpoints
- jeagleston1131056@direct.osumc.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 35.148903 | OH | Yes |
Addresses
Primary practice location
715 Richland Mall
Ontario, OH 44906-3802
Mailing address
700 N Columbus St
Crestline, OH 44827-1455
Phone (419) 462-3485
Other providers in Ontario, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.