Randi Marie Bustin, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9104629 Issued in FL

Practice address

1502 E Fowler Ave
Tampa, FL 33612-5416

Phone

(813) 866-0950

Fax

(813) 866-0929

NPI assigned

Nov 4, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Randi Marie Marmalich Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Observation Medical Group LLC

  • Emergency Medicine Physician
  • Tampa, FL
  • NPI 1952763682
  Medicare reassignment NPD
• Emergency Medical Associates of Tampa Bay, LLC

  • Emergency Medicine Physician
  • Tampa, FL
  • NPI 1023397817
  Medicare reassignment

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319760000000",
    "number": "1003069022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82969",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336822969",
            "telephone_number": "813-866-0930",
            "fax_number": "813-866-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 E FOWLER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336125416",
            "telephone_number": "813-866-0950",
            "fax_number": "813-866-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTIN",
        "first_name": "RANDI",
        "middle_name": "MARIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-04",
        "last_updated": "2011-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000694400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RANDI",
            "last_name": "MARMALICH",
            "middle_name": "MARIE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shayla Bussey
• Brandon Bustamante, SW19004
• Edson Guillermo Bustamante, D.M.D.
• Azhar Bustami
• Katrina Maria Bustani
• Emily Busto
• Victor M Bustos, DMD, PL
• Busy Bees Inc
• Doris Evelyn Butcher, ARNP
• Velma Butcher

• Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.