Active NPI
Michelle Busch
- Physician Assistant
- Saint Louis, MO
National Provider Identifier
1760585087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 03863
- Practice address
- 12647 Olive Blvd
Suite 600
Saint Louis, MO 63141-6345 - Phone
- (800) 325-3982
- NPI assigned
- Sep 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 03863 | TX | Primary |
Addresses
Primary practice location
12647 Olive Blvd
Suite 600
Saint Louis, MO 63141-6345
Mailing address
554 County Road 385
San Antonio, TX 78253-6802
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03863 | TX | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athens Family Medicine LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Athens, GA
- NPI 1427418391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760585087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "554 COUNTY ROAD 385",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782536802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"address_2": "SUITE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416345",
"telephone_number": "800-325-3982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSCH",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "03863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
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.