MEDICARE: DR. ELWIN G BUSTOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	0101048655	VA
2	302R00000X	Health Maintenance Organization	MD19909	DC
3	261QP2300X	Primary Care Clinic/Center	MD19909	DC
4	305S00000X	Point of Service	MD19909	DC
5	305R00000X	Preferred Provider Organization	MD19909	DC
6	207RN0300X	Nephrology Physician	MD19909	DC
7	302R00000X	Health Maintenance Organization	0101048655	VA
8	305R00000X	Preferred Provider Organization	D0042936	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	110167563	OTHER		RAILROAD
4	541897047	OTHER		ALL OTHER INSURANCES
5	96121	OTHER		AMERIGROUP
6	44320001	OTHER		BCBSHIELD
7	0401616	OTHER		EVERCARE MARYLAND
8	1059	OTHER		ELDER HEALTH
9	09D0948025	OTHER	DC	CLIA
10	S10081	OTHER		CHARTERED HEALTH PLAN
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467543686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELWIN G BUSTOS MD

Provider Business Mailing Address
First Line	:	1140 VARNUM ST NE STE 202
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2153
Country	:	US
Telephone Number	:	202-269-6430
Fax Number	:	202-269-6598

Provider Business Practice Location Address
First Line	:	1140 VARNUM ST NE STE 202
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2153
Country	:	US
Telephone Number	:	202-269-6430
Fax Number	:	202-269-6598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	10/03/2025

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Directions to “ DR. ELWIN G BUSTOS MD” Practice Location

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