NPIMap

Organization Active NPI

Bustleton Mental Health Institute, Inc

  • Community/Behavioral Health Agency
  • Philadelphia, PA
National Provider Identifier
1891992442
Registry record updated Jan 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
129270 Issued in PA
Legal business name
BUSTLETON MENTAL HEALTH INSTITUTE, INC
Practice address
9551 Bustleton Ave Ste 2B
Philadelphia, PA 19115-3800
Phone
(215) 464-3838
Fax
(215) 464-3899
NPI assigned
Jun 28, 2007
Last updated
Jan 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2024

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

Authorized official

Name
Mr. Vladimir Platonov, M.D.NPI 1700040383
Title
Facility Director
Phone
(215) 464-3838

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 129270 PA
Community/Behavioral Health Agency 251S00000X 129270 PA Primary

Addresses

Primary practice location

9551 Bustleton Ave Ste 2B
Philadelphia, PA 19115-3800

Mailing address

9551 Bustleton Ave Ste 2B
Philadelphia, PA 19115-3800
Phone (215) 464-3838

Other practice location 1

1701A Grant Ave.
Philadelphia, PA 19115-3160
Phone (215) 464-3838

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070827000012 PA Part B Supplier - Clinic/Group Practice 6507958261 Receives reassigned benefits from 1 practitioner
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory

Locations

1701 Grant Ave
#A
Philadelphia, PA 19115
Phone (215) 464-3838

9551 Bustleton Ave
Ste 2B
Philadelphia, PA 19115
Phone (215) 464-3838

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1891992442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9551 BUSTLETON AVE STE 2B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191153800",
            "telephone_number": "215-464-3838",
            "fax_number": "215-464-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9551 BUSTLETON AVE STE 2B",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191153800",
            "telephone_number": "215-464-3838",
            "fax_number": "215-464-3899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701A GRANT AVE.",
            "address_purpose": "LOCATION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191153160",
            "country_code": "US",
            "telephone_number": "215-464-3838",
            "fax_number": "215-464-3899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BUSTLETON MENTAL HEALTH INSTITUTE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "PLATONOV",
        "authorized_official_first_name": "VLADIMIR",
        "authorized_official_title_or_position": "FACILITY DIRECTOR",
        "authorized_official_telephone_number": "215-464-3838",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "PA",
            "license": "129270",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "129270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.