NPIMap

Organization Active NPI

Bustleton Healthcare

  • Primary Care Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1588107668
Registry record updated Nov 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
MD 435017 Issued in PA
Legal business name
BUSTLETON HEALTHCARE
Practice address
9867 Bustleton Ave
Suite B
Philadelphia, PA 19115-2611
Phone
(215) 698-9295
NPI assigned
Nov 22, 2016
Organization subpart
Yes
Parent organization
CARDIOLOGY CONSULTANTS OF GREATER PHILADELPHIA PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 22, 2016

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

Authorized official

Name
Irina Joukova
Title
President
Phone
(267) 307-9236

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X MD 435017 PA
Primary Care Clinic/Center 261QP2300X MD 435017 PA Primary

Addresses

Primary practice location

9867 Bustleton Ave
Suite B
Philadelphia, PA 19115-2611

Mailing address

9867 Bustleton Ave
Suite B
Philadelphia, PA 19115-2611

Other identifiers 1

IdentifierTypeStateIssuer
102790572 0001MedicaidPA

National Provider Directory

National Provider Directory
Part of
Bustleton Healthcare

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479772800000",
    "number": "1588107668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9867 BUSTLETON AVE",
            "address_2": "SUITE B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9867 BUSTLETON AVE",
            "address_2": "SUITE B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191152611",
            "telephone_number": "215-698-9295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUSTLETON HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARDIOLOGY CONSULTANTS OF GREATER PHILADELPHIA PC",
        "enumeration_date": "2016-11-22",
        "last_updated": "2016-11-22",
        "status": "A",
        "authorized_official_last_name": "JOUKOVA",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "267-307-9236"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "PA",
            "license": "MD 435017",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "PA",
            "license": "MD 435017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102790572 0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.