Active NPI
Michael J. Bussa, DDS
- General Practice Dentistry
- Duluth, MN
National Provider Identifier
1124146345
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Feb 19, 2015.
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9268
- Practice address
- 324 W Superior St
Suite 628
Duluth, MN 55802-1701 - Phone
- (218) 722-7271
- Fax
- (218) 722-7271
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9268 | MN | Primary |
Addresses
Primary practice location
324 W Superior St
Suite 628
Duluth, MN 55802-1701
Mailing address
324 W Superior St
Suite 628
Duluth, MN 55802-1701
Phone (218) 722-7271
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9268 | MN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124146345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 W SUPERIOR ST",
"address_2": "SUITE 628",
"city": "DULUTH",
"state": "MN",
"postal_code": "558021701",
"telephone_number": "218-722-7271",
"fax_number": "218-722-7271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 W SUPERIOR ST",
"address_2": "SUITE 628",
"city": "DULUTH",
"state": "MN",
"postal_code": "558021701",
"telephone_number": "218-722-7271",
"fax_number": "218-722-7271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSSA",
"first_name": "MICHAEL",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "9268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.