Individual provider Active NPI

Benjamin S Bass, DDS

  • General Practice Dentistry
  • Brooklyn, NY
National Provider Identifier
1164622015
Registry record updated Jul 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
34495 Issued in NY
Practice address
1801 Avenue N Apt 1a
Brooklyn, NY 11230-6184
Phone
(718) 339-7400
Fax
(718) 339-6503
NPI assigned
Jul 19, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 34495 NY Primary

Addresses

Primary practice location

1801 Avenue N Apt 1a
Brooklyn, NY 11230-6184

Mailing address

1801 Avenue N Apt 1a
Brooklyn, NY 11230-6184
Phone (718) 339-7400

Other identifiers 1

IdentifierTypeStateIssuer
034495MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20160614002002 NY Order and Referring Only - DentistPractitioner - Dentist 0840592515

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34495NYMDGeneral Practice Dentistry
034495NYMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184803200000",
    "number": "1164622015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 AVENUE N APT 1A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112306184",
            "telephone_number": "718-339-7400",
            "fax_number": "718-339-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 AVENUE N APT 1A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112306184",
            "telephone_number": "718-339-7400",
            "fax_number": "718-339-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASS",
        "first_name": "BENJAMIN",
        "middle_name": "S",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2007-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "34495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034495",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.