1780673616 NPI number — JAMES C BASS III MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780673616 NPI number — JAMES C BASS III MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BASS

Provider First Name:

JAMES

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

III

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1780673616

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/06/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

55 FRUIT ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOSTON

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02114-2696

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

55 FRUIT ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BOSTON

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02114-2696

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-354-4432

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  MD09191 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 203290 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0204X , with the licence number: 203290 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 003122984 . This is a "MED ASSISTANCE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 007006228 . This is a "HOSPITAL PIN" identifier . This identifiers is of the category "OTHER".
• Identifier: 009191 . This is a "BLUESHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 2013231 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000001988 . This is a "NHPRI" identifier . This identifiers is of the category "OTHER".
• Identifier: 720071201 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 3198243 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
• Identifier: 401338 . This is a "BLUECHIP" identifier . This identifiers is of the category "OTHER".
• Identifier: 240541 . This is a "RIH PILGRIM" identifier . This identifiers is of the category "OTHER".
• Identifier: 7006699 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 778790 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1600203 . This is a "UNITED HEALTH PLANS" identifier . This identifiers is of the category "OTHER".