Ahmed Bashir Raddad

Primary specialty

DentistTaxonomy code 122300000X

License

DE61188502 Issued in WA

Practice address

1051 Columbia Ave
Connell, WA 99326-8702

Phone

(509) 488-5256

Fax

(509) 488-9939

NPI assigned

Jul 10, 2020

Last updated

Oct 2, 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ahmed.raddad.1@21034.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.

• Columbia Basin Health Association

  dba Eagle Eye Care

  • Federally Qualified Health Center (FQHC)
  • Connell, WA
  • NPI 1528316379
  Medicare reassignment NPD
• Columbia Basin Health Association

  • Federally Qualified Health Center (FQHC)
  • Pasco, WA
  • NPI 1225716947
  NPD

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1134747603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E COLUMBIA ST",
            "city": "OTHELLO",
            "state": "WA",
            "postal_code": "993441846",
            "telephone_number": "509-488-5256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 COLUMBIA AVE",
            "city": "CONNELL",
            "state": "WA",
            "postal_code": "993268702",
            "telephone_number": "509-488-5256",
            "fax_number": "509-488-9939"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Newton St # 707A",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021183552",
            "country_code": "US",
            "telephone_number": "617-358-8360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RADDAD",
        "first_name": "AHMED",
        "middle_name": "BASHIR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-10",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61188502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Franklin School District
• Our Lady of Lourdes Health Center (Lourdes Family Health Center)
• Jessica Pearl, ARNP
• Lana Shaha Phillips, CCC-SLP
• George Francis Quiggle, LMHC
• Shane Ririe, PA-C
• Kiley Sauder
• Lois Eileen Smith, CDP
• Carol Stockhausen, DDS
• Jonathan Jay Walker, O.D.

• Dentist in Connell, WA
• Providers in Connell, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.