JASON JUSTICE
NPI 1417417361
Student in an Organized Health Care Education/Training Program in Charleston, WV

Active since March 25, 2019PECOS Enrolled
3100 MACCORKLE AVE SE STE 700, CHARLESTON, WV 25304(304) 351-1500 Get Directions Write a Review

NPPES record last updated: February 27, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Jason Justice NPPES

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

JASON JUSTICE (NPI 1417417361) is an individual student in an organized health care education/training program in Charleston, West Virginia, licensed in West Virginia (ED1254) and active in the NPI registry since March 2019. He is enrolled in Medicare PECOS and maintains a secondary practice location in Prestonsburg.

NPPES Registry Identity

NPI1417417361
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJASON JUSTICE
Location Address3100 MACCORKLE AVE SE STE 700Charleston, WV 25304-1230
Mailing Address400 Association Dr Ste 102Charleston, WV 25311-1298
Sole ProprietorYes
Enumeration DateMarch 25, 2019
Last NPPES UpdateFebruary 27, 2026
NPPES CertifiedFebruary 27, 2026
NPI 1417417361 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Taxonomy Code390200000X
License Licensed in WV · ED1254
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedCommunity Health WorkerTaxonomy 172V00000X
3100 MACCORKLE AVE SE STE 700, Charleston, WV 25304

Secondary Practice Location 1

Location 1104 S Front AvePrestonsburg, KY 41653-1614 · Phone (606) 886-8572 · Fax (606) 886-4433

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Jason Justice is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

Internal Medicine (Critical Care Medicine)
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304
Surgery
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304
Internal Medicine (Endocrinology, Diabetes & Metabolism)
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304
Internal Medicine
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304
Internal Medicine
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304
Family Medicine
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304
Nurse Practitioner (Family)
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304
Surgery
3100 MACCORKLE AVE SE STE 700
CHARLESTON, WV 25304

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1417417361, enumerated as an "individual" on March 25, 2019.

The provider is located at 3100 MACCORKLE AVE SE STE 700 CHARLESTON, WV 25304 and the phone number is (304) 351-1500.

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.