Individual provider Active NPI

Sean P Bush, M.D.

  • Emergency Medicine Physician
  • New Haven, CT
National Provider Identifier
1184739872
Registry record updated Mar 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A52112 Issued in CA
Practice address
464 Congress Ave Ste 260
New Haven, CT 06519-1362
Phone
(252) 917-9311
NPI assigned
Aug 20, 2006
Last updated
Mar 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A52112 CA Primary

Addresses

Primary practice location

464 Congress Ave Ste 260
New Haven, CT 06519-1362

Mailing address

3657 Macgregor Downs Rd
Greenville, NC 27834-7409
Phone (252) 917-9311

Other identifiers 1

IdentifierTypeStateIssuer
00A521120MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130828000017 NC Practitioner - Emergency Medicine 9830253525 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Texas a & M University System, HSC, College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Granville Health SystemGroup PAC ID 1052223757, shared by 8 NPIs, 78 clinicians

Practice addresses (Care Compare)

1614 NC Hwy 56
Creedmoor, NC 27522-8297
Phone (919) 575-6103

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A52112CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC CurrentSince Jun 10, 2022 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Jun 10, 2022 Accepting new patients
Wakemed Specialists Group, LLC Current Accepting new patients
Kinston Physicians Group, PLLC Emergency Medicine CurrentSince Feb 1, 2020 Accepting new patients

Locations

811 US 70 Hwy W
Garner, NC 27529
Phone (919) 235-6565

100 Airport Rd
Kinston, NC 28501
Phone (252) 522-7000

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: sbush525786@direct.medicine.duke.edu

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614988800000",
    "number": "1184739872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3657 MACGREGOR DOWNS RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278347409",
            "telephone_number": "252-917-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 CONGRESS AVE STE 260",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191362",
            "telephone_number": "252-917-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "SEAN",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2021-03-06",
        "certification_date": "2021-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A52112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A521120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.