Active NPI
Katelyn R Busacca, RD, LDN
- Registered Dietitian
- Berlin, MD
National Provider Identifier
1609387679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86029792
- Practice address
- 9714 Healthway Dr
Berlin, MD 21811-1154 - Phone
- (410) 641-3340
- Fax
- (410) 641-3341
- NPI assigned
- Oct 18, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86029792 | MD | Primary |
Addresses
Primary practice location
9714 Healthway Dr
Berlin, MD 21811-1154
Mailing address
10026 Old Ocean City Blvd Ste 1
Berlin, MD 21811-1288
Phone (410) 629-6007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86029792 | MD | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlantic Immedicare LLC | Past | Accepting new patients |
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.
-
- General Practice Physician
- Ocean City, MD
- NPI 1518199223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508284800000",
"number": "1609387679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10026 OLD OCEAN CITY BLVD STE 1",
"city": "BERLIN",
"state": "MD",
"postal_code": "218111288",
"telephone_number": "410-629-6007",
"fax_number": "410-641-9515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9714 HEALTHWAY DR",
"city": "BERLIN",
"state": "MD",
"postal_code": "218111154",
"telephone_number": "410-641-3340",
"fax_number": "410-641-3341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSACCA",
"first_name": "KATELYN",
"middle_name": "R",
"credential": "RD, LDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-18",
"last_updated": "2017-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MD",
"license": "86029792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berlin, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.