Individual provider Active NPI

Nathan Tyler Bush, PA-C

  • Medical Physician Assistant
  • Chesterton, IN
National Provider Identifier
1952187965
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone
(219) 921-1444
Fax
(219) 921-5303
NPI assigned
Sep 5, 2023
Last updated
Apr 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary
Surgical Physician Assistant 363AS0400X 10004155A IN

Addresses

Primary practice location

601 Gateway Blvd N
Chesterton, IN 46304-9658

Mailing address

896 N 104 W
Chesterton, IN 46304-9626
Phone (219) 928-6808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231120000208 IN Practitioner - Physician Assistant 9436507175 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2501 Cumberland Dr
Valparaiso, IN 46383-2503
Phone (219) 921-1444

3777 N Frontage Rd
Suite 900
Michigan City, IN 46360-7698
Phone (219) 921-1444

601 Gateway Blvd N
Chesterton, IN 46304-9658
Phone (219) 921-1444

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.8 of 100Reported as group
Quality
81.02
Improvement activities
40
Cost
74.12

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10004155AINMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Bone & Joint Institute, PC Multi-Specialty CurrentSince Jan 18, 2024 Accepting new patients
Lakeshore Bone & Joint Institute, PC Multi-Specialty Past Accepting new patients

Locations

601 Gateway Blvd N
Chesterton, IN 46304
Phone (219) 921-1401

3691 Willowcreek Rd
Portage, IN 46368
Phone (219) 759-4380

2501 Cumberland Dr
Valparaiso, IN 46383
Phone (219) 462-4481

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1693872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1952187965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "896 N 104 W",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049626",
            "telephone_number": "219-928-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GATEWAY BLVD N",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463049658",
            "telephone_number": "219-921-1444",
            "fax_number": "219-921-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "NATHAN",
        "middle_name": "TYLER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-05",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10004155A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterton, IN

Sources for this page

Verify at the official NPI Registry.