Rebecca L Bushong, M.D.
Individual provider Active NPI Dermatology Physician · Crawfordsville, IN
NPI 1366422099 · NPPES record last updated Feb 28, 2013
Key facts
- NPI
- 1366422099
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 01036464A (IN)
- Practice address
- 1601 Lafayette Rd
Suite 100
Crawfordsville, IN 47933-1032 - Phone
- (765) 362-1212
- Fax
- (765) 361-0210
- NPI assigned
- Jan 19, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040922000272 | IN | Practitioner - Dermatology | 0941278477 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015967 | ME | MD | Specialist |
| 35050655 | OH | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mina Swofford, M.D. P.C | Dermatology | Current |
Accepting new patients |
| Major Hospital | Past | Accepting new patients |
Locations
2101 Jackson St
Ste 118
Anderson, IN 46016
Phone (765) 313-7087
2101 Jackson St
Ste 205
Anderson, IN 46016
Phone (765) 683-3160
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 015967 | ME | |
| Specialist | 174400000X | 35050655 | OH | |
| Dermatology Physician | 207N00000X | 01036464A | IN | Yes |
Addresses
Primary practice location
1601 Lafayette Rd
Suite 100
Crawfordsville, IN 47933-1032
Mailing address
1601 Lafayette Rd
Suite 100
Crawfordsville, IN 47933-1032
Phone (765) 362-1212
Other providers in Crawfordsville, IN
- Keith A Brehob
- Shelbi Browning
- Bridget Buchanan
- Breanna Buck
- Alyssa Bueschel
- Joel Butcher
- Paula Naydine Byerly
- C. Richard Walker D.D.S., Inc.
- Corrina Cain
- Alisa J Calhoun
All providers in Crawfordsville, IN · Dermatology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.