NPIMap

Individual provider Active NPI

Charles Amos Bush II

  • Vascular Surgery Physician
  • Louisville, KY
National Provider Identifier
1619361680
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
56602 Issued in KY
Practice address
4003 Kresge Way Ste 300
Louisville, KY 40207-4652
Phone
(502) 897-5139
Fax
(502) 896-6218
NPI assigned
Mar 26, 2015
Last updated
Mar 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 01087790A IN
Student in an Organized Health Care Education/Training Program 390200000X
Vascular Surgery Physician 2086S0129X 56602 KY Primary

Addresses

Primary practice location

4003 Kresge Way Ste 300
Louisville, KY 40207-4652

Mailing address

5200 Commerce Crossings Dr FL 3
Louisville, KY 40229-2182
Phone (502) 253-4924

Other practice location 1

1919 State St Ste 200
New Albany, IN 47150-6804
Phone (502) 897-5139

Other practice location 2

4894 Reynolds Ln
Vestavia, AL 35242-7462
Phone (205) 876-3933

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220720001864 IN Practitioner - Vascular SurgeryPractitioner - General Practice 4385924653 Reassigns benefits to 1 organization
I20220815001128 KY Practitioner - Vascular SurgeryPractitioner - General Surgery 4385924653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Practice
Education
University of South Alabama College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, shared by 31 NPIs, 2,431 clinicians

Practice addresses (Care Compare)

1919 State St
Suite 200
New Albany, IN 47150-6804
Phone (502) 897-5139

4003 Kresge Way
Suite 228
Louisville, KY 40207-4652
Phone (502) 893-5100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)21
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
56602KYMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Medical Associates Inc CurrentSince Jan 22, 2024 Accepting new patients
Baptist Health Medical Group Inc Current Accepting new patients
Baptist Health Medical Group, Inc. CurrentSince Mar 18, 2024 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Jan 22, 2024 Accepting new patients
Baptist Healthcare System Inc. Past Accepting new patients

Locations

1373 N State Road 62
Madison, IN 47250
Phone (812) 801-0196

1850 State St
New Albany, IN 47150
Phone (812) 944-7701

1919 State St
Ste 200
New Albany, IN 47150
Phone (502) 897-5139

3900 Kresge Way
Ste 41
Louisville, KY 40207
Phone (502) 896-1313

4003 Kresge Way
Ste 228
Louisville, KY 40207
Phone (502) 893-5100

5200 Commerce Crossings Dr
Fl 3
Louisville, KY 40229
Phone (502) 253-4924

4003 Kresge Way
Ste 300
St Matthews, KY 40207
Phone (502) 893-7710

Organizations & group practices 6

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.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1619361680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 COMMERCE CROSSINGS DR FL 3",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402292182",
            "telephone_number": "502-253-4924",
            "fax_number": "502-489-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4003 KRESGE WAY STE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074652",
            "telephone_number": "502-897-5139",
            "fax_number": "502-896-6218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1919 State St Ste 200",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "IN",
            "postal_code": "471506804",
            "country_code": "US",
            "telephone_number": "502-897-5139",
            "fax_number": "502-896-6218",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4894 Reynolds Ln",
            "address_purpose": "LOCATION",
            "city": "Vestavia",
            "state": "AL",
            "postal_code": "352427462",
            "country_code": "US",
            "telephone_number": "205-876-3933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSH",
        "first_name": "CHARLES",
        "middle_name": "AMOS",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-26",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IN",
            "license": "01087790A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "KY",
            "license": "56602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.