Robert John Busch, DMD MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0021934 Issued in TX

Practice address

2807 N Knoxville Ave
Peoria, IL 61604-2869

Phone

(309) 682-1213

Fax

(309) 682-1213

NPI assigned

May 17, 2007

Last updated

Aug 12, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 18, 2015 through Aug 18, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Citizens Medical Center County of Victoria

  • General Acute Care Hospital
  • Victoria, TX
  • NPI 1124052162
  NPD (past)
• Houston Methodist Oral and Maxillofacial Surgeons, PLLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Houston, TX
  • NPI 1306646286
  NPD (past)
• Tmhpo Oral & Maxillofacial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Houston, TX
  • NPI 1174544738
  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1467669762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042869",
            "telephone_number": "309-682-1213",
            "fax_number": "309-682-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042869",
            "telephone_number": "309-682-1213",
            "fax_number": "309-682-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSCH",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "0021934",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "BP10028831",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177585009",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1467669762",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177585010",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX DENTAL",
            "identifier": "21934",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN IN TRAINING",
            "identifier": "BP10028831",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Burns, MD
• Joseph James Burrows
• Tammy Burtch
• Ashley Michelle Burton
• Jennifer Elaine Burton, MS, CGC
• Lisa M Busenitz Jablonski, CRNA
• Michael Lang Bushby, MOT, OTR/L
• Lori Bushell, LCPC
• Kayla Marie Buskirk
• Sheri K Buskirk, RN

• Oral and Maxillofacial Surgery (Dentist) in Peoria, IL
• Providers in Peoria, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.