MISS THERESA BUSHMAN PHD, RD, LD
NPI 1295618353
Dietitian, Registered in Minneapolis, MN

Q: What is Theresa Bushman's NPI number?

The NPI number for Theresa Bushman is 1295618353. It was assigned to this individual provider in the NPPES registry on July 28, 2025.

Q: What is Theresa Bushman's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Q: When was this NPI record last updated?

The NPPES record for Theresa Bushman was last updated on July 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 28, 2025PECOS Enrolled

2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454(920) 883-5305 Get Directions Write a Review

NPPES record last updated: July 28, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

On this page

About Miss Theresa Bushman Phd, Rd, Ld NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISS THERESA BUSHMAN PHD, RD, LD (NPI 1295618353) is an individual dietitian, registered in Minneapolis, Minnesota, licensed in Minnesota (5683) and active in the NPI registry since July 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1295618353

Entity TypeIndividualFemale

Primary Taxonomy133V00000X

Provider Legal NameMISS THERESA BUSHMANCredential: PHD, RD, LD

Location Address2450 RIVERSIDE AVEMinneapolis, MN 55454-1450

Mailing Address2450 Riverside AveMinneapolis, MN 55454-1450

Phone(920) 883-5305

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateJuly 28, 2025

NPPES CertifiedJuly 28, 2025

✔ NPI 1295618353 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

License✔ Licensed in MN · 5683

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

2450 RIVERSIDE AVE, Minneapolis, MN 55454

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miss Theresa Bushman Phd, Rd, Ld is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5496221848

PECOS Enrollment IDI20260414002789

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Theresa Bushman reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Fairview Express Care

Same address

Clinic/Center

2450 RIVERSIDE AVE, STE F140
Minneapolis, MN 55454

Reassigned Medicare billing, Minnesota enrollment
3,633 clinicians in this Medicare group

NPI 1841428745 (612) 672-6999

Fairview Clinics

0.1 mi

Clinic/Center

606 24TH AVE S, STE 602
Minneapolis, MN 55454

Reassigned Medicare billing, Minnesota enrollment
2,302 clinicians in this Medicare group

NPI 1043516867 (612) 273-6099

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55454 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $56.00 – $168.28

Typical copayment $0.00 (range $14.00 – $42.07)

Most-billed visit code NA

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELLE IRENE GRAY

Rehabilitation Practitioner