Stephen Thomas Bushi, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

M-5492 Issued in ID

Practice address

1902 Judith LN
Suite 110
Boise, ID 83705-5209

Phone

(208) 658-0800

Fax

(208) 323-1894

NPI assigned

Sep 13, 2005

Reactivated

Mar 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518480000000",
    "number": "1356336648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 JUDITH LN",
            "address_2": "SUITE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837055209",
            "telephone_number": "208-658-0800",
            "fax_number": "208-323-1894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 JUDITH LN",
            "address_2": "SUITE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837055209",
            "telephone_number": "208-658-0800",
            "fax_number": "208-323-1894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSHI",
        "first_name": "STEPHEN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2018-02-13",
        "deactivation_date": "2006-03-23",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-5492",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "ID",
            "license": "M-5492",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003533000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Aaron Burtelow, M.D.
• Madison Brooke Burton
• Suzanne Burton, LPC
• Caroline Brinson Bush, PTA
• Emily Michelle Bush, PHARMD
• Katie Butcher, APRN
• Alexandra Butler, MA, CCC-SLP
• David Merrill Butler, DO
• Renae Marie Butler, LMSW
• Asma M Butt, MD

• Psychiatry Physician in Boise, ID
• Providers in Boise, ID by specialty
• Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; 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.