NPIMap

Individual provider Active NPI

Jason Bustin, PA

  • Physician Assistant
  • Lebanon, MO
National Provider Identifier
1265732549
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2024011270 Issued in MO
Practice address
120 Hospital Dr Ste 100
Lebanon, MO 65536-9227
Phone
(417) 533-6751
NPI assigned
Nov 2, 2010
Last updated
May 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 21247 CA
Physician Assistant 363A00000X 2024011270 MO Primary

Addresses

Primary practice location

120 Hospital Dr Ste 100
Lebanon, MO 65536-9227

Mailing address

120 Hospital Dr Ste 100
Lebanon, MO 65536-9227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160712002983 SD Practitioner - Physician Assistant 7214113869 Reassigns benefits to 1 organization
I20240515001277 MO Practitioner - Physician Assistant 7214113869 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

120 Hospital Dr
Lebanon, MO 65536-9227

120 Hospital Dr
Lebanon, MO 65536-9230
Phone (417) 820-5750

1605 Martin Springs Dr
Rolla, MO 65401-2980

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1020SDMDChiropractor
21247CAMDSpeech-Language Pathologist
2024011270MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince May 6, 2024 Accepting new patients
Bennett County Hospital and Nursing Home CurrentSince Jan 27, 2022 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince May 6, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince May 6, 2024 Accepting new patients

Locations

120 Hospital Dr
Ste 100
Lebanon, MO 65536
Phone (417) 533-6751

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

102 Major Allen St
Martin, SD 57551
Phone (605) 685-6622

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1265732549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 HOSPITAL DR STE 100",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655369227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 HOSPITAL DR STE 100",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655369227",
            "telephone_number": "417-533-6751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTIN",
        "first_name": "JASON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-02",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "21247",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2024011270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, MO

Sources for this page

Verify at the official NPI Registry.