Mark Jay Bucksbaum, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

0420007956 Issued in VT

Practice address

69 Allen St
Ste 9
Rutland, VT 05701-4564

Phone

(417) 875-3000

NPI assigned

Mar 28, 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 2

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.

• Center for Integrative Medicine

  • Specialist
  • Rutland, VT
  • NPI 1609079763
  NPD (past) Authorized official

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1215997697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 ALLEN ST",
            "address_2": "STE 9",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014564",
            "telephone_number": "417-875-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 ALLEN ST",
            "address_2": "STE 9",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014564",
            "telephone_number": "417-875-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKSBAUM",
        "first_name": "MARK",
        "middle_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VT",
            "license": "0420007956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009492",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215997697",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tomas Francisco Browne, MS
• Ashley Elizabeth Brua
• Bruce D Bullock, MD PC
• Rachel Elaine Bruce, M.D.
• Grace Lyle Bruno, MSW
• Frank P. Buggiani, DPM
• Arabella Bull-Stewart, DO
• Bruce D Bullock, MD
• Elizabeth G Bullock, P.T.
• Kelsey Bullock, SLP

• All providers in Rutland, VT
• Physical Medicine & Rehabilitation Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.