Elise Noel Bascom, PH.D.

Key facts

NPI

1043853948

Entity type

Individual (NPI type 1)

Primary specialty

Psychologist 103T00000X

License

3154 (OR)

Practice address

1551 Pearl St
Eugene, OR 97401-4010

Phone

(541) 517-9733

NPI assigned

Oct 23, 2019

Sex

Female

Sole proprietor

No

Organizations & group practices 2

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.

• Sokyahealth Medical Group PC Mental Health Counselor · Portland, OR · NPI 1447842232
  Medicare reassignment Care Compare group NPD OR · PSYCHOLOGIST
• Vista Counseling & Consultation, Inc. Community/Behavioral Health Agency · Eugene, OR · NPI 1275864985
  Medicare reassignment NPD OR

Medicare Care Compare profile

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sokyahealth Medical Group PC (68 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Philosophy

State licenses

Practice roles (2 of 4)

Locations

Networks

• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e
• WA PPO C-SNP

Interoperability endpoints

• Direct secure messaging: elise.bascom.p1@direct.sokya.nextgenshare.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 15, 2023.

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1043853948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 PEARL ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014010",
            "telephone_number": "541-517-9733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PEARL ST",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014010",
            "telephone_number": "541-517-9733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASCOM",
        "first_name": "ELISE",
        "middle_name": "NOEL",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-23",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Eugene, OR · Psychologist in Oregon