Active NPI
Susan Ann Bussa
- Physical Therapist
- Duluth, MN
National Provider Identifier
1366471765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1855
- Practice address
- 4212 Grand Ave
Duluth, MN 55807-2737 - Phone
- (218) 786-3500
- NPI assigned
- Jun 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1855 | MN | Primary |
Addresses
Primary practice location
4212 Grand Ave
Duluth, MN 55807-2737
Mailing address
4212 Grand Ave
Duluth, MN 55807-2737
Phone (218) 786-3500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40256800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366471765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4212 GRAND AVE",
"city": "DULUTH",
"state": "MN",
"postal_code": "558072737",
"telephone_number": "218-786-3500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4212 GRAND AVE",
"city": "DULUTH",
"state": "MN",
"postal_code": "558072737",
"telephone_number": "218-786-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSSA",
"first_name": "SUSAN",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "1855",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40256800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.