Nissim Bassoul, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

1861601 Issued in NY

Practice address

2490 Ocean Pkwy
Brooklyn, NY 11235-6132

Phone

(718) 496-4607

Fax

(718) 382-1920

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DFDFAA
• FHIR API: https://epwebapps.acpny.com/FHIRproxy/ACPNY/api/FHIR/R4
• FHIR API: https://fhir4.healow.com/fhir/r4/DFDFAA/Endpoint/DFDFAA
• Direct secure messaging: nissimbassoul@mai.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advantagecare Physicians PC

  • General Practice Physician
  • New York, NY
  • NPI 1336578772
  Medicare reassignment NPD
• Bedford Stuyvesant Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
  • NPI 1033178561
  Medicare reassignment NPD
• Advantagecare Physicians PC

  • Internal Medicine Physician
  • Staten Island, NY
  • NPI 1063954113
  NPD
• Bedford Stuyvesant Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
  • NPI 1528836590
  NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD
• Marie Laura Leon M.D P.C

  • Pediatric Adolescent Medicine Physician
  • Brooklyn, NY
  • NPI 1750456406
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1023071701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 OCEAN PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112356132",
            "telephone_number": "718-496-4607",
            "fax_number": "718-382-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 OCEAN PKWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112356132",
            "telephone_number": "718-496-4607",
            "fax_number": "718-382-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASSOUL",
        "first_name": "NISSIM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "1861601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Elizabeth Bassler, PHD
• Brian S Bassner, MS ED
• Deidre Bassolino, PHD
• Albert Bassoul, MD FAAP
• Myra Bassoul
• Jeffrey J Basti, MD
• Stacy Bastien-Renelique, M.S. CCC-SLP
• Aurelie Anya Bastien, RN
• Carol Bastien, LCSW
• Daniel Bastien, RPH

• Pediatrics Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.