Individual provider Active NPI

Tarif Bakdash, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Lexington, KY
National Provider Identifier
1104141712
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
58549 Issued in KY
Practice address
2195 Harrodsburg Rd FL 2
Lexington, KY 40504-3516
Phone
(859) 562-1868
Fax
(859) 257-0421
NPI assigned
Apr 7, 2010
Last updated
Nov 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2012014535 MO
Pediatrics Physician 208000000X 4301055614 MI
Pediatrics Physician 208000000X 12298 MT
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 4301055614 MI
Neurology Physician 2084N0400X 63034 WI
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 63034 WI
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 24539 MS
Clinical Neurophysiology Physician 2084N0600X 58549 KY
Clinical Neurophysiology Physician 2084N0600X 63034 WI
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 58549 KY Primary

Addresses

Primary practice location

2195 Harrodsburg Rd FL 2
Lexington, KY 40504-3516

Mailing address

2195 Harrodsburg Rd FL 2
Lexington, KY 40504-3516

Other identifiers 7

IdentifierTypeStateIssuer
431560263OtherMOTRICARE
P01110482OtherMORR MCR
12298OtherMTLICENSE
192753001MedicaidAR
200435170AMedicaidOK
05127841MedicaidMS
1104141712MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, KY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150415002446 WI Practitioner - Neurology 1456483767 Reassigns benefits to 1 organization
I20231009002595 KY Practitioner - NeurologyPractitioner - Neuropsychiatry 1456483767 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12298MTMDPharmacist
58549KYMDNeurology with Special Qualifications in Child Neurology Physician
4301055614MIMDNeurology with Special Qualifications in Child Neurology Physician
63034WIMDClinical Neurophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Medical Services Foundation, Inc Pediatrics CurrentSince Sep 25, 2023 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Oct 1, 2014 Accepting new patients
University of Kentucky CurrentSince Sep 25, 2023 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Ozarks Medical Center Neurology Past Accepting new patients
Commission for Children With Special Health Car Past Accepting new patients

Locations

1900 Richmond Rd
Lexington, KY 40502
Phone (856) 266-2101

2195 Harrodsburg Rd
Lexington, KY 40504
Phone (859) 323-2232

2195 Harrodsburg Rd
Ste 2
Lexington, KY 40504
Phone (859) 323-8082

2400 Greatstone Pt
Lexington, KY 40504
Phone (859) 257-9800

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: tbakdash309247@ukhcdirect.org

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1104141712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2195 HARRODSBURG RD FL 2",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405043516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 HARRODSBURG RD FL 2",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405043516",
            "telephone_number": "859-562-1868",
            "fax_number": "859-257-0421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKDASH",
        "first_name": "TARIF",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-07",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2012014535",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301055614",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MT",
            "license": "12298",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MI",
            "license": "4301055614",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "63034",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "WI",
            "license": "63034",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "MS",
            "license": "24539",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "KY",
            "license": "58549",
            "primary": false
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "WI",
            "license": "63034",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "KY",
            "license": "58549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "431560263",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "P01110482",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "12298",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192753001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200435170A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05127841",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104141712",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.