Abraham Velasco Bustamante, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1003 Koala Dr
Omak, WA 98841-9247

Phone

(800) 660-2129

NPI assigned

Oct 21, 2024

Last updated

Dec 11, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Physician Assistant

Education

University of Washington School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Health CentersGroup PAC ID 9739076217, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Valley Hospital Hospital, Tonasket, WA, CCN 501321
• Mid Valley Hospital & Clinic Hospital, Omak, WA, CCN 501328

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: abraham.velasco.bustamante.1@19043.direct.athenahealth.com

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.

• Family Health Centers

  • Federally Qualified Health Center (FQHC)
  • Okanogan, WA
  • NPI 1609804392
  Medicare reassignment Care Compare group NPD

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

• Okanogan County Public Hospital Dist No 4

  • Critical Access Hospital
  • Tonasket, WA
  • NPI 1164580700
  Care Compare affiliation
• Okanogan County Public Hospital District No. 3

  dba Mid-Valley Hospital

  • Critical Access Hospital
  • Omak, WA
  • NPI 1255387403
  Care Compare affiliation

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

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1669293908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 GOLDEN RD",
            "city": "OROVILLE",
            "state": "WA",
            "postal_code": "988449766",
            "telephone_number": "206-639-5761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 KOALA DR",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419247",
            "telephone_number": "800-660-2129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELASCO BUSTAMANTE",
        "first_name": "ABRAHAM",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-21",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ulloa
• Valley Counseling and Wellness PLLC
• Debra Louise Vanbrunt
• Maricela Vargas
• Jennifer Vazquez
• Blair Noel Velez-Kelsey, MHCP
• Wal-Mart Stores Inc (Vision Center 30-1947)
• Shelly M Waldern, ARNP FNP-BC
• Katie Renee Walker, MSW
• Barbara J Wallace, LICSW

• Medical Physician Assistant in Omak, WA
• Providers in Omak, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.