NPIMap

Individual provider Active NPI

Kevin Wayne Busdiecker, AA

  • Anesthesiologist Assistant
  • Cleveland, OH
National Provider Identifier
1528073004
Registry record updated Sep 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
67-000036 Issued in OH
Practice address
2500 Metro Health Drive
Cleveland, OH 44109
Phone
(216) 778-5790
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 67-000036 OH Primary

Addresses

Primary practice location

2500 Metro Health Drive
Cleveland, OH 44109

Mailing address

2500 Metro Health Drive
Cleveland, OH 44109
Phone (216) 778-5790

Other identifiers 7

IdentifierTypeStateIssuer
414955OtherOHWELLCARE MEDICAID
000000232158OtherOHUNISON
0583328OtherOHBCMH
9724074OtherOHAETNA
000000515962OtherOHANTHEM
430037559OtherOHRAILROAD MEDICARE
2739264MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070425000338 OH Practitioner - Anesthesiology Assistant 0345345005 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
78.79 of 100Reported as group
Quality
71.01
Improvement activities
40
Cost
82.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
33OHMDAthletic Trainer
67-000036OHMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System Past Accepting new patients
University Hospitals Cleveland Medical Center Past Accepting new patients
Michael E Jones MD PA PastSince Nov 1, 2009 Accepting new patients

Organizations & group practices 4

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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253491200000",
    "number": "1528073004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 METRO HEALTH DRIVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44109",
            "telephone_number": "216-778-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 METRO HEALTH DRIVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44109",
            "telephone_number": "216-778-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSDIECKER",
        "first_name": "KEVIN",
        "middle_name": "WAYNE",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2009-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "OH",
            "license": "67-000036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE MEDICAID",
            "identifier": "414955",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000232158",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMH",
            "identifier": "0583328",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9724074",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000515962",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "430037559",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2739264",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; 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.