Individual provider Active NPI

Melanie Bustamante, PA-C

  • Physician Assistant
  • Clermont, FL
National Provider Identifier
1073350906
Registry record updated Jan 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2345 E Hwy 50
Clermont, FL 34711-6053
Phone
(352) 717-3760
NPI assigned
Jul 9, 2024
Last updated
Jan 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

2345 E Hwy 50
Clermont, FL 34711-6053

Mailing address

2349 E Hwy 50
Clermont, FL 34711-6053
Phone (352) 717-3760

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241210000140 FL Practitioner - Physician Assistant 5496280968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4660 13TH St
Saint Cloud, FL 34769-6765
Phone (407) 200-2300

7385 Cypress Gardens Blvd SE
Winter Haven, FL 33884-3246
Phone (863) 852-2551

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System/Sunbelt, Inc Physician Assistant CurrentSince Oct 28, 2024 Accepting new patients
Adventist Health System/Sunbelt, Inc Physician Assistant CurrentSince Oct 28, 2024 Accepting new patients

Locations

2349 E Highway 50
Clermont, FL 34711
Phone (352) 717-3760

2600 Westhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 200-1353

4660 13th St
Saint Cloud, FL 34769
Phone (321) 805-4650

Interoperability endpoints

  • Direct secure messaging: mbustamante4031373@adventhealth.direct-ci.com

Organizations & group practices 3

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 4

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": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737763200000",
    "number": "1073350906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2349 E HWY 50",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347116053",
            "telephone_number": "352-717-3760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2345 E HWY 50",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347116053",
            "telephone_number": "352-717-3760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "MELANIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-09",
        "last_updated": "2025-01-25",
        "certification_date": "2025-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.