Individual provider Active NPI

Daysy Bustamante, RD

  • Registered Dietitian
  • Fort Worth, TX
National Provider Identifier
1437936200
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
101 Summit Ave Ste 907
Fort Worth, TX 76102-2613
Phone
(469) 372-2022
Fax
(833) 290-5413
NPI assigned
Sep 13, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

101 Summit Ave Ste 907
Fort Worth, TX 76102-2613

Mailing address

17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905
Phone (469) 372-2022

Other practice location 1

17060 Dallas Pkwy Ste 112
Dallas, TX 75248-1905
Phone (469) 372-2022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250401001239 TX Practitioner - Registered Dietitian Or Nutrition Professional 7810410750 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Doherty Nutrition LLCGroup PAC ID 0941610273, 16 clinicians

Practice addresses (Care Compare)

17060 Dallas Pkwy
Suite 112
Dallas, TX 75248-1905
Phone (469) 372-2022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Doherty Nutrition LLC Dietitian, Registered CurrentSince Jan 26, 2025 Accepting new patients

Locations

650 Warrenville Rd
Ste 100
Lisle, IL 60532
Phone (331) 300-3102

17060 Dallas Pkwy
Ste 112
Dallas, TX 75248
Phone (469) 372-2022

101 Summit Ave
Ste 907
Fort Worth, TX 76102
Phone (817) 438-8044

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1437936200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17060 DALLAS PKWY STE 112",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481905",
            "telephone_number": "469-372-2022",
            "fax_number": "833-290-5413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SUMMIT AVE STE 907",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761022613",
            "telephone_number": "469-372-2022",
            "fax_number": "833-290-5413"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17060 Dallas Pkwy Ste 112",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752481905",
            "country_code": "US",
            "telephone_number": "469-372-2022",
            "fax_number": "833-290-5413",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "DAYSY",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.