Jeffrey M Bastasic, MD
Individual provider Active NPI Family Medicine Physician · Menasha, WI
NPI 1164547600 · NPPES record last updated Jan 6, 2021
Key facts
- NPI
- 1164547600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 52366 (WI)
- Practice address
- 878 W Airport Rd
Menasha, WI 54952-1461 - Phone
- (920) 727-5982
- NPI assigned
- Mar 21, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Medical College of Wisconsin, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ascension Medical Group-Fox Valley Wisconsin, Inc
Practice addresses (Care Compare)
101 Main St
Neenah, WI 54956-2570
Phone (920) 727-4200
1420 Algoma St
New London, WI 54961-2104
Phone (920) 982-8300
1501 S Madison St
Appleton, WI 54915-1846
Phone (920) 738-2000
1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000
1855 S Koeller St
Oshkosh, WI 54902-6186
Phone (920) 223-7000
200 Patriot Dr
Little Chute, WI 54140-1184
Phone (920) 687-2800
2700 W 9TH Ave
Oshkosh, WI 54904-7247
3329 N Richard St
Appleton, WI 54911-1063
Phone (920) 380-2715
916 E Main St
Winneconne, WI 54986-9782
Phone (920) 582-1100
W6981 Parkview Dr
Greenville, WI 54942-8034
Phone (920) 882-2400
Hospital & facility affiliations
- Ascension NE Wisconsin - St Elizabeth Campus
- Ascension Calumet Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101112001099 | WI | Practitioner - Family Practice | 0840485025 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52366 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Current |
Accepting new patients | |
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Current |
Accepting new patients |
Locations
1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435
878 W Airport Rd
Menasha, WI 54952
Phone (920) 727-5982
101 Main St
Neenah, WI 54956
Phone (920) 727-4200
2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 52366 | WI | Yes |
Addresses
Primary practice location
878 W Airport Rd
Menasha, WI 54952-1461
Mailing address
878 W Airport Rd
Menasha, WI 54952-1461
Phone (920) 727-5982
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jeffrey.bastasic.1@10114.direct.athenahealth.com |
Other providers in Menasha, WI
- Marianna Baizabal Andrade
- Heather Ann Bancroft
- Jeanette S. Bantamoi
- John R Barkmeier
- Rachel A Bass
- Matthew A Bayer
- Steven Beau
- Emily Bebout
- Jean Marie Behm
- Sara Elizabeth Behm
All providers in Menasha, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.