NPIMap

Individual provider Active NPI

Sarah Bustos, M.D.

  • Family Medicine Physician
  • Kohler, WI
National Provider Identifier
1396908505
Registry record updated Feb 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
62136-020 Issued in WI
Practice address
950 Woodlake Rd
Kohler, WI 53044-1348
Phone
(920) 496-4700
NPI assigned
Jul 8, 2008
Last updated
Feb 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD.31121 AL
Family Medicine Physician 207Q00000X MT193190 PA
Family Medicine Physician 207Q00000X 62136-020 WI Primary

Addresses

Primary practice location

950 Woodlake Rd
Kohler, WI 53044-1348

Mailing address

950 Woodlake Rd
Kohler, WI 53044-1348
Phone (920) 496-4700

Other practice location 1

1411 N Taylor Dr
Sheboygan, WI 53081-3043
Phone (920) 496-4700

Other names 1

  • Ms. Sarah Morallo Olaso Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141110001603 WI Practitioner - Family Practice 9335311208 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progressive Beginnings, LLCGroup PAC ID 7012189848, 19 clinicians

Practice addresses (Care Compare)

1125 N 13TH St
Sheboygan, WI 53081-3281
Phone (920) 803-1617

1411 N Taylor Dr
Sheboygan, WI 53081-3043
Phone (920) 457-4858

15 S 10TH St
Suite a
Oostburg, WI 53070-1370
Phone (920) 552-5046

1703 N Taylor Dr
Sheboygan, WI 53081-1933
Phone (920) 496-4700

3100 Superior Ave
Sheboygan, WI 53081-1948
Phone (920) 459-8300

3113 Saemann Ave
Sheboygan, WI 53081-1957
Phone (920) 496-4700

950 Woodlake Rd
Kohler, WI 53044-1348
Phone (920) 783-3150

PO Box
Suite 19070
Green Bay, WI 54307-9070

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.31121ALMDFamily Medicine Physician
MT193190PAMDFamily Medicine Physician
62136-020WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis Family Medicine CurrentSince Sep 22, 2014 Accepting new patients
Prevea Clinic, Inc. Family Medicine CurrentSince Sep 22, 2014 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Sep 22, 2014 Accepting new patients
Prevea Clinic, Inc. Family Medicine CurrentSince Sep 22, 2014 Accepting new patients
Professional Resource Management of Wiregrass, LLC Past Accepting new patients

Locations

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

950 Woodlake Rd
Kohler, WI 53044
Phone (920) 783-3150

1411 N Taylor Dr
Sheboygan, WI 53081
Phone (920) 457-1600

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 6

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": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1396908505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 WOODLAKE RD",
            "city": "KOHLER",
            "state": "WI",
            "postal_code": "530441348",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 WOODLAKE RD",
            "city": "KOHLER",
            "state": "WI",
            "postal_code": "530441348",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 N Taylor Dr",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530813043",
            "country_code": "US",
            "telephone_number": "920-496-4700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSTOS",
        "first_name": "SARAH",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-08",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "MD.31121",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT193190",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "62136-020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARAH",
            "last_name": "OLASO",
            "middle_name": "MORALLO",
            "prefix": "MS.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kohler, WI

Sources for this page

Verify at the official NPI Registry.