Individual provider Active NPI

Yizhak Bushwick, D.C.

  • Chiropractor
  • Baltimore, MD
National Provider Identifier
1790024537
Registry record updated Aug 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
S03745 Issued in MD
Practice address
1120 N Charles St
Suite 301
Baltimore, MD 21201-5592
Phone
(410) 522-7746
Fax
(410) 510-1844
NPI assigned
Feb 13, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC010700 PA
Chiropractor 111N00000X S03745 MD Primary

Addresses

Primary practice location

1120 N Charles St
Suite 301
Baltimore, MD 21201-5592

Mailing address

1120 N Charles St
Suite 301
Baltimore, MD 21201-5592
Phone (410) 522-7746

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140508000476 MD Practitioner - Chiropractic 8224261722 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1736 Eastern Ave
Baltimore, MD 21231-2422
Phone (410) 522-7746

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC010700PAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Stutman Chiropractic PC Chiropractor CurrentSince May 1, 2014 Accepting new patients

Locations

2833 Smith Ave
Ste 124
Baltimore, MD 21209

1120 N Charles St
Ste 301
Baltimore, MD 21201
Phone (410) 522-7746

3450 Laurel Fort Meade Rd
Ste 100
Laurel, MD 20724
Phone (240) 436-2225

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.

NPI Registry JSON

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376870400000",
    "number": "1790024537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 N CHARLES ST",
            "address_2": "SUITE 301",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015592",
            "telephone_number": "410-522-7746",
            "fax_number": "410-510-1844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N CHARLES ST",
            "address_2": "SUITE 301",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015592",
            "telephone_number": "410-522-7746",
            "fax_number": "410-510-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSHWICK",
        "first_name": "YIZHAK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-13",
        "last_updated": "2013-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC010700",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MD",
            "license": "S03745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.