Keith Samuel Bass, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277002840 Issued in IL

Practice address

513 N Main St
Anna, IL 62906-1668

Phone

(618) 833-4471

NPI assigned

Jul 21, 2017

Last updated

Jan 5, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: keith.bass.1@7601.direct.athenahealth.com

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.

• Claripath Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Anna, IL
  • NPI 1265317523
  Medicare reassignment NPD Authorized official
• Rural Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Anna, IL
  • NPI 1982666384
  Medicare reassignment NPD
• Rural Health, Inc.

  dba Rural Health Plus

  • Community/Retail Pharmacy
  • Anna, IL
  • NPI 1801634183
  NPD
• Rural Health, Inc.

  dba Dongola Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Dongola, IL
  • NPI 1366506628
  NPD (past)

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

{
    "created_epoch": "1500595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1114440179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 LYNWOOD LN",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629063265",
            "telephone_number": "217-898-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 N MAIN ST",
            "city": "ANNA",
            "state": "IL",
            "postal_code": "629061668",
            "telephone_number": "618-833-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASS",
        "first_name": "KEITH",
        "middle_name": "SAMUEL",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-21",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209015848",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277002840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arrowleaf
• Morgan Atherton
• Halley M Barke, PAC
• Anthony Shane Barker, RN
• Olivia Leann Barker, REGISTERED NURSE
• Nancy L Bass
• Steven M Beatty, M.D.
• Danece Lynn Bennett, APRN
• Tessa Lea Binversie, D.C.
• Randall D Boen, MS, CRC, LCPC

• Family Nurse Practitioner in Anna, IL
• Providers in Anna, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.