Gladys T Bush, HEALTH COACH CCMA

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

60312804 Issued in NY

Practice address

9501 Chase Way
Shreveport, LA 71118-4619

Phone

(318) 773-0657

Fax

(318) 688-1559

NPI assigned

Jan 30, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Excellence Physician Billing

  • Supports Brokerage Agency
  • Shreveport, LA
  • NPI 1912230228
  NPD (past) Authorized official
• Gallego Health

  • Clinic/Center
  • Shreveport, LA
  • NPI 1992219836
  NPD

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1891326690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19284",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711490284",
            "telephone_number": "318-773-0657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9501 CHASE WAY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711184619",
            "telephone_number": "318-773-0657",
            "fax_number": "318-688-1559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "GLADYS",
        "middle_name": "T",
        "credential": "HEALTH COACH CCMA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "NY",
            "license": "60312804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCMA",
            "identifier": "K5C6Y6M8",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "shreveport",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9501 Chase Way",
            "city": "Shreveport",
            "state": "LA",
            "country_code": "US",
            "postal_code": "711184619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Zachary Burton
• Olivia Mina Bury I
• Caitlin Favaloro Busada, MD
• Matthew Busby
• Steven James Busenbarrick, MSW, LCSW
• Karen M Bush, MCD CCC-SLP
• Nancy K Bushnell-Harper, MA, LPC
• Bridgett Bushnell, LCSW
• Veronica Bustos
• Butler Home Care Transportation, LLC

• Prevention Professional in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Prevention Professional in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.