Active NPI
Michele Marie Busch
- Speech-Language Pathologist
- Tierra Amarilla, NM
National Provider Identifier
1710040407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 3472
- Practice address
- State Road 531
Tierra Amarilla, NM 87575-9701 - Phone
- (505) 588-7285
- NPI assigned
- Dec 18, 2006
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3472 | NM | Primary |
Addresses
Primary practice location
State Road 531
Tierra Amarilla, NM 87575-9701
Mailing address
PO Box 496
Chama, NM 87520-0496
Phone (505) 756-1023
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61128007 | Medicaid | NM |
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 |
|---|---|---|---|
| 3472 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710040407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 496",
"city": "CHAMA",
"state": "NM",
"postal_code": "875200496",
"telephone_number": "505-756-1023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "STATE ROAD 531",
"city": "TIERRA AMARILLA",
"state": "NM",
"postal_code": "875759701",
"telephone_number": "505-588-7285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSCH",
"first_name": "MICHELE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "3472",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "61128007",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tierra Amarilla, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.