Jessica Marie Basham, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

01078045A Issued in IN

Practice address

515 N Lafayette Blvd
South Bend, IN 46601-1003

Phone

(574) 232-2037

Fax

(574) 232-1470

NPI assigned

Mar 20, 2013

Last updated

Jan 10, 2018By the provider in NPPES

Sex

Female

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 IN

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 1

Specialty

Obstetrics/Gynecology

Education

Indiana University School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The South Bend Clinic LLCGroup PAC ID 3779577937, 171 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et1296.epichosted.com/APIProxyPRD/api/FHIR/R4/
• Direct secure messaging: jbasham252619@dulyhealthandcare.direct-ci.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.

• The South Bend Clinic LLC

  • Clinic/Center
  • South Bend, IN
  • NPI 1073680419
  Medicare reassignment Care Compare group NPD
• Healthlinc, Inc.

  • Federally Qualified Health Center (FQHC)
  • Valparaiso, IN
  • NPI 1528262581
  Medicare reassignment NPD
• Healthlinc, Inc

  dba HealthLinc - Newton

  • Federally Qualified Health Center (FQHC)
  • Morocco, IN
  • NPI 1568354116
  NPD
• The South Bend Clinic, LLC

  • Anesthesiology Physician
  • South Bend, IN
  • NPI 1487307492
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Memorial Hospital of South Bend

  • General Acute Care Hospital
  • South Bend, IN
  • NPI 1295772093
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Memorial Epworth Center

  • Psychiatric Hospital Unit
  • South Bend, IN
  • NPI 1376841395
  Care Compare affiliation
• Memorial Hospital of South Bend

  dba Beacon Granger Hospital, A Memorial Hospital Extension

  • General Acute Care Hospital
  • Granger, IN
  • NPI 1881177756
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515542400000",
    "number": "1164764890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 UNIVERSITY COMMONS STE 230",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351590",
            "telephone_number": "574-251-2100",
            "fax_number": "574-251-2150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N LAFAYETTE BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011003",
            "telephone_number": "574-232-2037",
            "fax_number": "574-232-1470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 Arlington Ave",
            "address_2": "Graduate Medical Education, MS 1050",
            "address_purpose": "LOCATION",
            "city": "Toledo",
            "state": "OH",
            "postal_code": "436142595",
            "country_code": "US",
            "telephone_number": "419-383-4244",
            "fax_number": "419-383-3108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASHAM",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-20",
        "last_updated": "2018-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IN",
            "license": "01078045A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Obstetrics & Gynecology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.