Shirley Prasetyo Buntoro, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

U4752 Issued in TX

Practice address

1 Guthrie SQ
Sayre, PA 18840-1625

Phone

(570) 887-3585

NPI assigned

Mar 31, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Homecare Home health agency, Tyler, TX, CCN 743197
• Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sbuntoro316727@christushealth.direct-ci.net
• Direct secure messaging: sbuntoro158758@direct-guthrie.org

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.

• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  Family Medicine, TX

  Medicare reassignment Care Compare group NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  Care Compare group NPD
• Mother Frances Hospital Jacksonville

  • Critical Access Hospital
  • Jacksonville, TX
  • NPI 1952306672

  TX

  Medicare reassignment
• Christus Trinity Clinic

  • Durable Medical Equipment & Medical Supplies
  • New Braunfels, TX
  • NPI 1639807548
  Care Compare group
• Christus Trinity Clinic

  • Durable Medical Equipment & Medical Supplies
  • Shreveport, LA
  • NPI 1891422192
  Care Compare group
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Emory, TX
  • NPI 1033641105
  Care Compare group
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Canton, TX
  • NPI 1134313083
  Care Compare group
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Mineola, TX
  • NPI 1275727125
  Care Compare group
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Hawkins, TX
  • NPI 1396939146
  Care Compare group
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Quitman, TX
  • NPI 1497949341
  Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• LHCG Cxii, LLC

  • Home Health Agency
  • Tyler, TX
  • NPI 1669994471
  Care Compare affiliation
• Mother Frances Hospital Regional Health Care Center

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1831727239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 GREEN RIVER RD",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917891821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-887-3585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3802 Manhatton Dr",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757019451",
            "country_code": "US",
            "telephone_number": "903-509-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNTORO",
        "first_name": "SHIRLEY",
        "middle_name": "PRASETYO",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "U4752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sbuntoro158758@direct-guthrie.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1 Guthrie Sq",
            "city": "Sayre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "188401625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Klariza R Buda, CRNA
• Rasmita Budhathoki
• Anna Bui, MD
• Jessica Bulkley, OD
• Shawn Trevor Bunnell, AGNP
• Russell E Burkett, D.O.
• William Walter Cady, M.D.
• Burt Cagir, MD
• Joseph Cahill, D.O.
• Meghan Alexandra Callahan, D.O.

• All providers in Sayre, PA
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; 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.