NPIMap

Individual provider Active NPI

Crystal Lynn Bushman, NURSE PRACTITIONER

  • Nurse Practitioner
  • Wausau, WI
National Provider Identifier
1073291696
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
14163-33 Issued in WI
Practice address
2720 Plaza Dr Ste 1100
Wausau, WI 54401-4169
Phone
(715) 847-2472
NPI assigned
Jul 5, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 14163-33 WI Primary

Addresses

Primary practice location

2720 Plaza Dr Ste 1100
Wausau, WI 54401-4169

Mailing address

184188 Little Wolf Rd
Wittenberg, WI 54499-6052
Phone (715) 573-5804

Other practice location 1

4005 Community Center Dr
Weston, WI 54476-4139
Phone (715) 241-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230823000607 WI Practitioner - Nurse Practitioner 5799148839

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Wisconsin School of Medicine, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

29980 Network PL
Chicago, IL 60673-1299

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.53 of 100Reported as group
Quality
77.62
Promoting interoperability
100
Improvement activities
40
Cost
78.08

Merit-based Incentive Payment System (MIPS)

Final score
90.56 of 100Reported as group
Quality
87.43
Promoting interoperability
100
Improvement activities
40
Cost
78.24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14163WIMDPharmacist
14163-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Medical Group, Inc. Current Accepting new patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

5409 Vern Holmes Dr
Stevens Point, WI 54482
Phone (715) 342-1015

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

4005 Community Center Dr
Weston, WI 54476
Phone (715) 241-5400

Interoperability endpoints

  • Direct secure messaging: crystal.bushman@337248305217540.direct.elationemr.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1073291696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184188 LITTLE WOLF RD",
            "city": "WITTENBERG",
            "state": "WI",
            "postal_code": "544996052",
            "telephone_number": "715-573-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 PLAZA DR STE 1100",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014169",
            "telephone_number": "715-847-2472"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4005 Community Center Dr",
            "address_purpose": "LOCATION",
            "city": "Weston",
            "state": "WI",
            "postal_code": "544764139",
            "country_code": "US",
            "telephone_number": "715-241-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSHMAN",
        "first_name": "CRYSTAL",
        "middle_name": "LYNN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "14163-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.