Individual provider Active NPI

Dana Emerson Basu, PSYD

  • Clinical Psychologist
  • Newport Beach, CA
National Provider Identifier
1023267549
Registry record updated Nov 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY24579 Issued in CA
Practice address
2549 Eastbluff Dr # 134
Newport Beach, CA 92660-3500
Phone
(608) 575-2111
Fax
(949) 220-7004
NPI assigned
Sep 9, 2008
Last updated
Nov 17, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY24579 CA Primary

Addresses

Primary practice location

2549 Eastbluff Dr # 134
Newport Beach, CA 92660-3500

Mailing address

2549 Eastbluff Dr # 134
Newport Beach, CA 92660-3500
Phone (608) 575-2111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130814000940 CA Practitioner - Clinical Psychologist 3274775671 Practice locations: Newport Beach, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2549 Eastbluff Dr
Newport Beach, CA 92660-3500
Phone (949) 415-8807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY24579CAMDClinical Psychologist
24579CAMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447718400000",
    "number": "1023267549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2549 EASTBLUFF DR # 134",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603500",
            "telephone_number": "608-575-2111",
            "fax_number": "949-220-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2549 EASTBLUFF DR # 134",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603500",
            "telephone_number": "608-575-2111",
            "fax_number": "949-220-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASU",
        "first_name": "DANA",
        "middle_name": "EMERSON",
        "name_prefix": "Ms.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2015-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY24579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.