Bradly Robert Bush, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019021954 Issued in IL

Practice address

1500 Park Avenue
Saint Louis, MO 63104-3024

Phone

(314) 898-1700

Fax

(314) 814-8542

NPI assigned

Sep 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d
• IA HMO C-SNP

Interoperability endpoints

• Direct secure messaging: bradly.bush.p1@direct.affiniahealthcare.nextgenshare.com

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.

• Affinia Healthcare

  • Dentist
  • Saint Louis, MO
  • NPI 1346634003
  NPD (past)
• Affinia Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1740067719
  NPD (past)

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1033219712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 BIDDLE ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631063454",
            "telephone_number": "314-898-1700",
            "fax_number": "314-814-8542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 PARK AVENUE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631043024",
            "telephone_number": "314-898-1700",
            "fax_number": "314-814-8542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "BRADLY",
        "middle_name": "ROBERT",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019021954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debbie Busche
• Rosalie Mary Buscher, PHYSICAL THERAPIST
• Julie Buschmann
• Claudia Louise Buschmeyer, R.N.
• Alexandra Elizabeth Bush-Kaufman, RDN
• Brenda D. Bush, NP-C
• Cori Anika Bush, RN
• Danielle N Bush, LPC
• Lisa Bush, DENTIST
• Megan Bush, DNP, APRN, CPNP-PC

• Dentist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.