Individual provider Active NPI

Doris V Pablo-Bustos, M.D.

  • Internal Medicine Physician
  • Washington, DC
National Provider Identifier
1275635559
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD30307 Issued in DC
Practice address
1140 Varnum St NE PMB 202
Washington, DC 20017-2151
Phone
(202) 269-6430
Fax
(202) 269-6598
NPI assigned
Sep 5, 2006
Last updated
Oct 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 0101056019 VA
Primary Care Clinic/Center 261QP2300X MD30307 DC
Exclusive Provider Organization 302F00000X D0058776 MD
Exclusive Provider Organization 302F00000X MD30307 DC
Exclusive Provider Organization 302F00000X 0101056019 VA
Health Maintenance Organization 302R00000X MD30307 DC
Health Maintenance Organization 302R00000X 0101056019 VA
Health Maintenance Organization 302R00000X D0058776 MD
Preferred Provider Organization 305R00000X 0101056019 VA
Preferred Provider Organization 305R00000X MD30307 DC
Preferred Provider Organization 305R00000X D0058776 MD
Point of Service 305S00000X MD30307 DC
Point of Service 305S00000X 0101056019 VA
Point of Service 305S00000X D0058776 MD
Internal Medicine Physician 207R00000X MD30307 DC Primary

Addresses

Primary practice location

1140 Varnum St NE PMB 202
Washington, DC 20017-2151

Mailing address

1140 Varnum St NE PMB 202
Washington, DC 20017-2151
Phone (202) 269-6430

Other practice location 1

6408 Seven Corners Place Ste C
Falls Church, VA 22044-2011
Phone (703) 237-1197

Other identifiers 4

IdentifierTypeStateIssuer
050883700MedicaidDC
510223500MedicaidMD
F811-0001OtherVACAREFIRST BCBS
033872900MedicaidDC

Other names 1

  • Doris Pablo-Bustos Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20100709000175 DC Practitioner - Internal Medicine 5193857191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

6408 Seven Corners PL
Suite C
Falls Church, VA 22044-2011
Phone (703) 237-1197

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
25 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
83.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD30307DCMDPrimary Care Clinic/Center
D0058776MDMDHealth Maintenance Organization
0101056019VAMDPoint of Service

Practice roles

OrganizationSpecialtyStatusNew patients
Doris Pablo-Bustos, MD PC Internal Medicine CurrentSince Apr 1, 2002 Accepting new patients
Bustos Associates LLC Primary Care Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1140 Varnum St NE
Ste 105
Washington, DC 20017
Phone (202) 269-6430

1140 Varnum St NE
Ste 202
Washington, DC 20017
Phone (202) 269-6430

6408 Seven Corners Pl
Ste C
Falls Church, VA 22044
Phone (703) 237-1197

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 8

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": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1275635559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 VARNUM ST NE PMB 202",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172151",
            "telephone_number": "202-269-6430",
            "fax_number": "202-269-6598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 VARNUM ST NE PMB 202",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172151",
            "telephone_number": "202-269-6430",
            "fax_number": "202-269-6598"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6408 Seven Corners Place Ste C",
            "address_purpose": "LOCATION",
            "city": "Falls Church",
            "state": "VA",
            "postal_code": "220442011",
            "country_code": "US",
            "telephone_number": "703-237-1197",
            "fax_number": "202-269-6598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PABLO-BUSTOS",
        "first_name": "DORIS",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-05",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "0101056019",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "DC",
            "license": "MD30307",
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MD",
            "license": "D0058776",
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "DC",
            "license": "MD30307",
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "VA",
            "license": "0101056019",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "DC",
            "license": "MD30307",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "VA",
            "license": "0101056019",
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "MD",
            "license": "D0058776",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "VA",
            "license": "0101056019",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "DC",
            "license": "MD30307",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MD",
            "license": "D0058776",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "DC",
            "license": "MD30307",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "VA",
            "license": "0101056019",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MD",
            "license": "D0058776",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "DC",
            "license": "MD30307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050883700",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510223500",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS",
            "identifier": "F811-0001",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "033872900",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DORIS",
            "last_name": "PABLO-BUSTOS",
            "credential": "MD PC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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Sources for this page

Verify at the official NPI Registry.