NPIMap

Individual provider Active NPI

Jason Mark Bussanich, D.C.

  • Chiropractor
  • Portland, OR
National Provider Identifier
1174787584
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3853 Issued in OR
Practice address
2031 E Burnside St
Portland, OR 97214-1649
Phone
(503) 224-2100
Fax
(503) 224-2129
NPI assigned
Jul 15, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3853 OR Primary

Addresses

Primary practice location

2031 E Burnside St
Portland, OR 97214-1649

Mailing address

2031 E Burnside St
Portland, OR 97214-1649
Phone (503) 224-2100

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grant T Dawson DC PC Chiropractor PastSince Jul 18, 2007 Accepting new patients
Locke Chiropractic LLC PastSince May 9, 2015 Accepting new patients
Portland Chiropractic Group Inc Chiropractor PastSince Jan 20, 2011 Accepting new patients
J M Bussanich, LLC Chiropractor PastSince Apr 20, 2013 Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236902400000",
    "number": "1174787584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141649",
            "telephone_number": "503-224-2100",
            "fax_number": "503-224-2129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2031 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141649",
            "telephone_number": "503-224-2100",
            "fax_number": "503-224-2129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSSANICH",
        "first_name": "JASON",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-15",
        "last_updated": "2009-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "3853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; 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.