Active NPI
Vickie Consuella71 Bush
- In Home Supportive Care Agency
- Valdosta, GA
National Provider Identifier
1912464702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- Practice address
- 3701 Bermuda Run Dr
Valdosta, GA 31605-1059 - Phone
- (229) 292-0021
- NPI assigned
- Feb 27, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 456669 | GA | |
| In Home Supportive Care Agency | 253Z00000X | Primary |
Addresses
Primary practice location
3701 Bermuda Run Dr
Valdosta, GA 31605-1059
Mailing address
3701 Bermuda Run Dr
Valdosta, GA 31605-1059
Phone (229) 292-0021
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 456669 | Other | GA | ARRT |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 456669 | GA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551312000000",
"number": "1912464702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3701 BERMUDA RUN DR",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316051059",
"telephone_number": "229-292-0021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3701 BERMUDA RUN DR",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316051059",
"telephone_number": "229-292-0021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "VICKIE",
"middle_name": "CONSUELLA71",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-27",
"last_updated": "2019-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "GA",
"license": "456669",
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARRT",
"identifier": "456669",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.