Rudolph Bustamante, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

6500 Issued in AZ

Practice address

1856 E Florence Blvd
Casa Grande, AZ 85122-5303

Phone

(520) 381-0380

Fax

(520) 836-1826

NPI assigned

Mar 24, 2006

Sex

Male

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 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Sun Life Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Eloy, AZ
  • NPI 1588876429
  NPD (past)
• Sun Life Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Florence, AZ
  • NPI 1902278252
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1124088968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10097",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851300020",
            "telephone_number": "520-836-3446",
            "fax_number": "520-836-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1856 E FLORENCE BLVD",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851225303",
            "telephone_number": "520-381-0380",
            "fax_number": "520-836-1826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "RUDOLPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "6500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z137312",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510984",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "03-1881",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "03-31815",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "ZFQ31815",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bessie Lynn Burk, FNP-BC
• Joanna Burnett, MA, BCBA, LBA
• Christine Rae Burris
• Tristen Jade Burton, CMT, CA
• Aliya Lynn Bush
• Gary J. Butler, M.S.
• Butterfly Hands Health Services PLLC
• Bernard Butts, LISAC
• Melissa Ann Byram, MD
• C & J Vip & Shuttle Service, LLC

• Pediatrics Physician in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.