Individual provider Active NPI

Michael Ronald Buckmaster, N.P.

  • Adult Health Nurse Practitioner
  • Kokomo, IN
National Provider Identifier
1609043827
Registry record updated Dec 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
28142494A Issued in IN
Practice address
3505 S Reed Rd
Kokomo, IN 46902-3838
Phone
(765) 453-8666
Fax
(765) 453-8506
NPI assigned
May 15, 2008
Last updated
Dec 16, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 28142494A IN Primary

Addresses

Primary practice location

3505 S Reed Rd
Kokomo, IN 46902-3838

Mailing address

3505 S Reed Rd
Kokomo, IN 46902-3838
Phone (765) 453-8666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200708000372 IN Order and Referring Only - Nurse Practitioner 9537210257

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28142494AINMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Healthcare Associates LLP Adult Health Current Accepting new patients

Locations

3834 S Emerson Ave
Ste C
Indianapolis, IN 46203
Phone (317) 782-1577

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387152000000",
    "number": "1609043827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 S REED RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023838",
            "telephone_number": "765-453-8666",
            "fax_number": "765-453-8506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 S REED RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023838",
            "telephone_number": "765-453-8666",
            "fax_number": "765-453-8506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKMASTER",
        "first_name": "MICHAEL",
        "middle_name": "RONALD",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-15",
        "last_updated": "2013-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "28142494A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

Verify at the official NPI Registry.