Samantha Lyn Bustillos, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

63807 Issued in NM

Practice address

4085 Egyptian St
Las Cruces, NM 88005-3573

Phone

(575) 636-7408

NPI assigned

Jul 14, 2021

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 NM

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

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acosta Urgent CaresGroup PAC ID 5193182277, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samantha.bustillos.1@24301.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 and National Provider Directory roles.

• Acosta Urgent Cares

  • Urgent Care Clinic/Center
  • Las Cruces, NM
  • NPI 1669176095
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1689246159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4085 EGYPTIAN ST",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053573",
            "telephone_number": "575-636-7408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4085 EGYPTIAN ST",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053573",
            "telephone_number": "575-636-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSTILLOS",
        "first_name": "SAMANTHA",
        "middle_name": "LYN",
        "credential": "NURSE  PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "63807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William J Bussey, MD
• Carlos Bustamante
• Jennica Bustamante
• Manuel A. Bustamante
• Noemi Correa Bustillos, COTA/L
• Samuel Correa Bustillos, ACNP-AG
• Briana Radosevich Bustos, CCC-SLP
• Busy Bee Psychological Services Inc
• Ashley J Butler IV, MCJ, MPA
• Karen Marie Butler

• Family Nurse Practitioner in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; 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.