Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

NICHOLAS ROBERT BUSSA
NPI 1679964357
Dentist in St Louis Park, MN

Q: What is Nicholas Bussa's NPI number?

The NPI number for Nicholas Bussa is 1679964357. It was assigned to this individual provider in the NPPES registry on February 17, 2015.

Q: What is Nicholas Bussa's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Bussa was last updated on October 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 25 days 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 February 17, 2015PECOS Enrolled

4600 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416(952) 926-3392 Get Directions Write a Review

NPPES record last updated: October 6, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 6, 2026, Sep 12, 2017 (2 updates tracked since 2017).

On this page

About Nicholas Robert Bussa NPPES

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

NICHOLAS ROBERT BUSSA (NPI 1679964357) is an individual dentist in St Louis Park, Minnesota, licensed in Minnesota (D13556) and active in the NPI registry since February 2015. He is enrolled in Medicare PECOS and maintains a secondary practice location in Woodbury.

NPPES Registry Identity

NPI1679964357

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameNICHOLAS ROBERT BUSSA

Location Address4600 EXCELSIOR BLVDSt Louis Park, MN 55416-4938

Mailing Address4600 Excelsior BlvdSt Louis Park, MN 55416-4938

Phone(952) 926-3392

Sole ProprietorYes

Enumeration DateFebruary 17, 2015

Last NPPES UpdateOctober 6, 20262 updates tracked since enumeration

NPPES CertifiedOctober 6, 2026

✔ NPI 1679964357 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in MN · D13556

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

4600 EXCELSIOR BLVD, St Louis Park, MN 55416

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Secondary Practice Location 1

Location 1604 Bielenberg Dr Ste 230Woodbury, MN 55125-1733 · Phone (612) 279-5410

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HRI Dental & Vision, Paramount.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicholas Robert Bussa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55416 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

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$69.74 typical visit price

range $18.32 – $138.04

Typical copayment $17.43 (range $4.58 – $34.51)

Most-billed visit code 99213

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

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

JAIN DENTAL ST. LOUIS PARK, PLLC

Clinic/Center (Dental)

4600 EXCELSIOR BLVD
ST LOUIS PARK, MN 55416

Hennepin County (952) 926-3392

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicholas Bussa's NPI number?

The NPI number for Nicholas Bussa is 1679964357. It was assigned to this individual provider in the NPPES registry on February 17, 2015.

Where is Nicholas Bussa located?

Nicholas Bussa practices at 4600 Excelsior Blvd, St Louis Park, MN 55416. The listed phone number is (952) 926-3392.

What is Nicholas Bussa's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Nicholas Bussa enrolled in Medicare?

Yes. Nicholas Bussa is registered in the Medicare PECOS enrollment system.

What insurance does Nicholas Bussa accept?

Health plans from HRI Dental & Vision and Paramount list Nicholas Bussa as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Nicholas Bussa was last updated on October 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 25 days 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.