DR. JUSTIN SHAWN CUMMINS MD
NPI 1003911603
Orthopaedic Surgery in Ashland, WI

Active since September 14, 2006PECOS EnrolledAccepts Medicare Assignment
89.68/100
CMS Quality Rating
1615 MAPLE LANE, ASHLAND, WI 54806(715) 685-5500 Get Directions Write a Review

NPPES record last updated: August 29, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Justin Shawn Cummins Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JUSTIN SHAWN CUMMINS MD (NPI 1003911603) is an individual orthopaedic surgery provider in Ashland, Wisconsin, licensed in Wisconsin (53249-20) and active in the NPI registry since September 2006. He is enrolled in Medicare PECOS, is affiliated with St Lukes Hospital, and is a graduate of University Of Washington School Of Medicine (2002).

NPPES Registry Identity

NPI1003911603
Entity TypeIndividualMale
Primary Taxonomy207X00000X
Provider Legal NameDR. JUSTIN SHAWN CUMMINSCredential: MD
Location Address1615 MAPLE LANEAshland, WI 54806
Mailing Address1615 Maple LaneAshland, WI 54806 · (715) 685-5500
Sole ProprietorNo
Medical School CMSUniversity Of Washington School Of MedicineGraduated 2002
Enumeration DateSeptember 14, 2006
Last NPPES UpdateAugust 29, 2018
NPI 1003911603 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyOrthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207X00000X
Licenses Licensed in WI · 53249-20 Licensed in MN · 51884
Definition
An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.
1615 MAPLE LANE, Ashland, WI 54806

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Justin Shawn Cummins Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7416003215
PECOS Enrollment IDI20090921000201, I20091001000154
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

X-ray of knee, 4 or more views 73564
An X-ray of the knee, 4 or more views, is a non-invasive imaging test. It involves capturing multiple images of your knee from different angles. This helps in diagnosing conditions such as fractures, arthritis, or infections. The procedure is quick and painless.
20 services16 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
14 services14 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
14 services14 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
12 services12 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Lukes Hospital

Acute Care Hospitals · Duluth, MN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240047
Location915 East 1st StreetDuluth, MN 55805 · St. Louis County
Emergency services Birthing friendly

St Marys Hospital Superior

Critical Access Hospitals · Superior, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number521329
Location3500 Tower AveSuperior, WI 54880 · Douglas County
Emergency services

Tamarack Health Hayward Medical Center

Critical Access Hospitals · Hayward, WI
OwnershipVoluntary non-profit - Private
CMS Certification Number521336
Location11040 N State Rd 77Hayward, WI 54843 · Sawyer County
Emergency services

Tamarack Health Ashland Medical Center

Critical Access Hospitals · Ashland, WI
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number521359
Location1615 Maple LaneAshland, WI 54806 · Ashland County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54806 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.92 typical visit price
range $53.90 – $163.24
Typical copayment $20.73 (range $13.47 – $40.81)
Most-billed visit code 99203
Established Patient
$67.37 typical visit price
range $17.40 – $133.76
Typical copayment $16.84 (range $4.35 – $33.44)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

89.68/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality81.23
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Anesthetist, Certified Registered
1615 MAPLE LANE
ASHLAND, WI 54806
Physician Assistant
1615 MAPLE LANE
ASHLAND, WI 54806
Physician Assistant
1615 MAPLE LANE
ASHLAND, WI 54806
Family Medicine
1615 MAPLE LANE
ASHLAND, WI 54806
Obstetrics & Gynecology
1615 MAPLE LANE
ASHLAND, WI 54806
Registered Nurse
1615 MAPLE LANE, MEMORIAL MEDICAL CENTER INC BEHAVIORAL HEALTH SERVICE
ASHLAND, WI 54806
Family Medicine
1615 MAPLE LANE
ASHLAND, WI 54806
Emergency Medicine
1615 MAPLE LANE
ASHLAND, WI 54806

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Justin Cummins's NPI number?

The NPI number for Justin Cummins is 1003911603. It was assigned to this individual provider in the NPPES registry on September 14, 2006.

Where is Justin Cummins located?

Justin Cummins practices at 1615 Maple Lane, Ashland, WI 54806. The listed phone number is (715) 685-5500.

What is Justin Cummins's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.

Is Justin Cummins enrolled in Medicare?

Yes. Justin Cummins is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Justin Cummins accept?

Health plans from Aspirus Health Plan, HealthPartners and Security Health Plan list Justin Cummins as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Justin Cummins affiliated with any hospitals?

According to CMS data, Justin Cummins is affiliated with St Lukes Hospital, St Marys Hospital Superior, Tamarack Health Hayward Medical Center and Tamarack Health Ashland Medical Center.

When was this NPI record last updated?

The NPPES record for Justin Cummins was last updated on August 29, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.