Maria Ximena Bustamante, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9110780 Issued in FL

Practice address

4061 Bonita Beach Rd Ste 101
Bonita Springs, FL 34134-4073

Phone

(239) 301-0105

Fax

(239) 288-7307

NPI assigned

Oct 6, 2017

Sex

Female

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 FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Endocrinology Institute of South FL LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Bonita Springs, FL
  • NPI 1366855975
  Medicare reassignment
• Internal Medicine Institute of South FL,LLC

  • Specialist
  • Naples, FL
  • NPI 1770997447
  NPD (past)

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

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1669982401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4061 BONITA BEACH RD STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341344073",
            "telephone_number": "239-301-0105",
            "fax_number": "239-288-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4061 BONITA BEACH RD STE 101",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341344073",
            "telephone_number": "239-301-0105",
            "fax_number": "239-288-7307"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14350 Metropolis Ave Ste 2",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339124430",
            "country_code": "US",
            "telephone_number": "239-301-0105",
            "fax_number": "239-288-7307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSTAMANTE",
        "first_name": "MARIA",
        "middle_name": "XIMENA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9110780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark David Bronner, DMD
• Erin Lynn Brouillard, PA-C
• William F Brown, P.T.C.
• Edmund David Brundell, DC
• Kyle Aaron Burton, M.D.
• C M Wallace DDS PA
• Zaida Camba
• Cambridge Medical Clinic of Florida, LLC
• Malliany Camejo Leonor
• Tiffany Marie Candy

• Physician Assistant in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.