Carrie Michael Bubenzer, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

200579 Issued in LA

Practice address

PO Box 8500 Lockbox 7642
Philadelphia, PA 19178-5682

Phone

(318) 226-3300

Fax

(318) 424-7610

NPI assigned

Sep 18, 2012

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BCHDDD

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.

• Arklatex Medical Consultants a Medical Corporation

  • Interventional Pain Medicine Physician
  • Shreveport, LA
  • NPI 1710466628

  Physician Assistant

  Medicare reassignment NPD
• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222
  Medicare reassignment
• Shriners Hospitals for Children

  • Children's Hospital
  • Shreveport, LA
  • NPI 1679617849
  Medicare reassignment
• Arklatex Medical Consultants a Medical Corporation

  • Durable Medical Equipment & Medical Supplies
  • Shreveport, LA
  • NPI 1225871700
  NPD
• Shriners Hospitals for Children

  • Clinic/Center
  • Aiea, HI
  • NPI 1568299857
  NPD
• Shriners Hospitals for Children

  • Rehabilitation Clinic/Center
  • Shreveport, LA
  • NPI 1851048821
  NPD
• Shriners Hospitals for Children

  • Orthopaedic Surgery Physician
  • Lexington, KY
  • NPI 1700223559
  NPD (past)

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

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723766400000",
    "number": "1205186152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8731 PARK PLAZA DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055682",
            "telephone_number": "318-797-5848",
            "fax_number": "318-797-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 8500 LOCKBOX 7642",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191785682",
            "telephone_number": "318-226-3300",
            "fax_number": "318-424-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUBENZER",
        "first_name": "CARRIE",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "200579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12513166",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2483854",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Elizabeth Bua
• Barry Bub, MD
• Radovan Bubanj, M.D.
• Bubbles Bubbles Bubbles,LLC
• Alyssa Louise Bubel
• Rochelle Pearl Bubis, DDS
• Domenick D. Bucci, M.D.
• Mary Bucci, BCABA
• Alexandra Nicole Buccino, RD, LDN
• Hilary A Bucell, LCSW

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2024; 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.