Amanda M Bustle, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704419600 Issued in MI

Practice address

2680 W Centre Ave
Portage, MI 49024-4828

Phone

(269) 324-2400

NPI assigned

Jan 20, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL, MI2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: direct@direct.bronsonhg.org

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.

• Bronson Methodist Hospital

  • Hospitalist Physician
  • Kalamazoo, MI
  • NPI 1417961137
  Medicare reassignment NPD
• Florida Community Health Centers Inc

  • Family Medicine Physician
  • Pahokee, FL
  • NPI 1851518211
  Medicare reassignment NPD
• Florida Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Port St Lucie, FL
  • NPI 1346619244
  Medicare reassignment NPD
• Florida Community Health Centers Inc

  • Family Medicine Physician
  • Clewiston, FL
  • NPI 1124078571
  NPD
• Florida Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Moore Haven, FL
  • NPI 1194071944
  NPD
• Florida Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Port St Lucie, FL
  • NPI 1215986872

  Pediatrics

  NPD
• Florida Community Health Centers Inc

  • Family Medicine Physician
  • Okeechobee, FL
  • NPI 1952351306
  NPD

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1114464765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5827 CORPORATE WAY",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072000",
            "telephone_number": "561-844-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 W CENTRE AVE",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244828",
            "telephone_number": "269-324-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5629 Stadium Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490091952",
            "country_code": "US",
            "telephone_number": "269-372-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2015 US Highway 441 N",
            "address_purpose": "LOCATION",
            "city": "Okeechobee",
            "state": "FL",
            "postal_code": "349721901",
            "country_code": "US",
            "telephone_number": "863-763-1951",
            "fax_number": "844-540-4798",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 W State St",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611022112",
            "country_code": "US",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSTLE",
        "first_name": "AMANDA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-20",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.014881",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704419600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson HealthCare Group Direct Address",
            "affiliationName": "Bronson HealthCare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carrie Burnett, RN
• Alton Burns
• Reella Lee Burrell
• Ann M. Busha, MD
• Ashley Bushong
• Jennifer Buysse
• Patricia Byrne, RPH
• Diana Calderon, OT
• Aerion Caldwell
• Erin Callahan

• Pediatric Nurse Practitioner in Portage, MI
• Providers in Portage, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.