Zachary W Bussen, PA-C
Physician Assistant in Rockford, IL. Individual provider (NPI-1).
NPI number1740913847
StatusActive
Last updated in NPPESSep 26, 2024
Details
- NPI
- 1740913847
- Entity type
- Individual (NPI-1)
- Name
- Zachary W Bussen
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 6, 2022
- Certification date
- Sep 26, 2024
- Last updated
- Sep 26, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 085010498 | IL | Yes |
| 363A00000X | Physician Assistant | 8072-23 | WI |
Practice location
5875 E Riverside BlvdRockford, IL 61114-4937
Phone 815-398-9491 · Fax 815-381-7498
Mailing address
5875 E Riverside BlvdRockford, IL 61114-4937
Phone 815-398-9491 · Fax 815-381-7498
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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