JUSTIN MARK BOOTH (AA) – Anesthesiologist Assistant, NPI 1306090675

JUSTIN MARK BOOTH (AA) is a healthcare provider. based in Valdosta, Georgia. specializing in ANESTHESIOLOGY ASSISTANT. They hold the professional credentials AA. They hold a License No. 005470 (GA). The NPI Number for JUSTIN MARK BOOTH (AA) is 1306090675

Main info

Male
18 Years Of Experience
Accepts Medicare Assignment
Name
JUSTIN MARK BOOTH (AA)
NPI
1306090675
Phone
(229) 244-6852
Address
2310 N PATTERSON ST
Enumeration Date
12 November 2008
Last Update Date
12 November 2008

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2292446852
Graduation Year
2008 (18 years ago)
PAC ID
2365503836
Group Practice PAC ID
0941296636
Professional Enrollment ID
I20081203000487
Address ID
GA316021735VA2501XSTXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience48
Completeness75
Years active:17State licenses:1Digital endpointsOther names

1,383 ANESTHESIOLOGY ASSISTANT in GA

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Provider Addresses for JUSTIN MARK BOOTH (AA)

  • 2310, North Patterson Street, Five Points, Valdosta, Lowndes County, Georgia, 31602, United States

    BLDG C

    VALDOSTA, GA 316022568

    Phone: (229) 244-6852

    Fax: (229) 242-2385

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 4 Open Payments records for all available years, with a total value of $124.

Total Amount is formed as General ($124) + Research ($0) + Ownership ($0) = $124.

Last reported payment date: 2024-05-27 • Largest payer in this snapshot: Edwards Lifesciences Corporation ($58).

Total Amount

$124

General + Research + Ownership

Payments

4

Total payment records

General Amount

$124

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-27

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2008-12-03

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20081203000487IAnesthesiology AssistantGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 31602)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0941296636View full group profile
NameSpecialtyState
Anesthesiology AssistantMO
Certified Registered Nurse Anesthetist (Crna)GA
Certified Registered Nurse Anesthetist (Crna)GA
Certified Registered Nurse Anesthetist (Crna)GA
Anesthesiology AssistantGA
-GA
Certified Registered Nurse Anesthetist (Crna)GA
Certified Registered Nurse Anesthetist (Crna)GA
A N E S T H E S I O L O G YNC
Certified Registered Nurse Anesthetist (Crna)GA

Reviews

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Frequently asked questions

Can I cross-check JUSTIN MARK BOOTH (AA) using NPI 1306090675?
NPI 1306090675 belongs to JUSTIN MARK BOOTH (AA); compare other details if you need extra assurance.
Is JUSTIN MARK BOOTH (AA) still an active registrant?
JUSTIN MARK BOOTH (AA) carries an active NPI according to the public dataset.
What area of care is associated with JUSTIN MARK BOOTH (AA)?
JUSTIN MARK BOOTH (AA)'s record emphasizes Anesthesiologist Assistant. Clinical services aligned with this taxonomy classification.
What locale is associated with JUSTIN MARK BOOTH (AA)?
Directory geography for JUSTIN MARK BOOTH (AA) centers on Valdosta, Georgia.
When was this NPI issued?
Enumeration for JUSTIN MARK BOOTH (AA) is noted as November 12, 2008 where the registry provides it.

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