Active NPI
Deidra L Bush
- General Practice Physician
- Chippewa Falls, WI
National Provider Identifier
1629925508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 304253-31
- Practice address
- 475 Chippewa Mall Dr
Chippewa Falls, WI 54729-5034 - Phone
- (715) 720-3780
- NPI assigned
- Mar 11, 2026
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 304253-31 | WI | Primary |
Addresses
Primary practice location
475 Chippewa Mall Dr
Chippewa Falls, WI 54729-5034
Mailing address
475 Chippewa Mall Dr
Chippewa Falls, WI 54729-5034
Phone (715) 720-3780
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 304253-31 | WI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1773187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773187200000",
"number": "1629925508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 CHIPPEWA MALL DR",
"city": "CHIPPEWA FALLS",
"state": "WI",
"postal_code": "547295034",
"telephone_number": "715-720-3780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 CHIPPEWA MALL DR",
"city": "CHIPPEWA FALLS",
"state": "WI",
"postal_code": "547295034",
"telephone_number": "715-720-3780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "DEIDRA",
"middle_name": "L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-03-11",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "WI",
"license": "304253-31",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chippewa Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.