Individual provider Active NPI

Mario Buss, PA-C

  • Physician Assistant
  • Galloway, NJ
National Provider Identifier
1265757876
Registry record updated Apr 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00424100 Issued in NJ
Practice address
318 Chris Gaupp Dr
Galloway, NJ 08205-4460
Phone
(609) 404-9900
Fax
(609) 404-3653
NPI assigned
Apr 7, 2010
Last updated
Apr 3, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2018

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 013933 NY
Physician Assistant 363A00000X 25MP00424100 NJ Primary

Addresses

Primary practice location

318 Chris Gaupp Dr
Galloway, NJ 08205-4460

Mailing address

155 Glenwood Rd
Elizabeth, NJ 07208-1139
Phone (908) 721-2318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20180411002209 NJ Practitioner - Physician Assistant 7214290956 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

318 Chris Gaupp Dr
Galloway, NJ 08205-4460
Phone (609) 404-9900

436 Chris Gaupp Dr
Suite 204
Galloway, NJ 08205-4488
Phone (609) 652-0100

459 Route 9 S
Little Egg Harbor TWP, NJ 08087-2225
Phone (609) 340-7815

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00424100NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Physician Group, PA CurrentSince Apr 1, 2018 Accepting new patients
Atlanticare Physician Group CurrentSince Apr 1, 2018 Accepting new patients

Locations

318 Chris Gaupp Dr
Galloway, NJ 08205
Phone (609) 404-9900

459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815

Organizations & group practices 3

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 1

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": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522713600000",
    "number": "1265757876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 GLENWOOD RD",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072081139",
            "telephone_number": "908-721-2318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 CHRIS GAUPP DR",
            "city": "GALLOWAY",
            "state": "NJ",
            "postal_code": "082054460",
            "telephone_number": "609-404-9900",
            "fax_number": "609-404-3653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSS",
        "first_name": "MARIO",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-07",
        "last_updated": "2018-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "013933",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00424100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galloway, NJ

Sources for this page

Verify at the official NPI Registry.