Individual provider Active NPI

Dallas Scott Basham, NP

  • Nurse Practitioner
  • Crestview Hills, KY
National Provider Identifier
1194758029
Registry record updated Mar 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3003742 Issued in KY
Practice address
350 Thomas More Pkwy
Suite 160
Crestview Hills, KY 41017-5465
Phone
(513) 221-1100
Fax
(513) 569-5297
NPI assigned
Jul 7, 2006
Last updated
Mar 21, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2016

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X COA.06624-NP OH
Nurse Practitioner 363L00000X 3003742 KY Primary
Acute Care Nurse Practitioner 363LA2100X COA.06624-NP OH
Acute Care Nurse Practitioner 363LA2100X 3003742 KY
Registered Nurse 163W00000X RN.178465-1 OH
Registered Nurse 163W00000X 1097793 KY

Addresses

Primary practice location

350 Thomas More Pkwy
Suite 160
Crestview Hills, KY 41017-5465

Mailing address

PO Box 643398
Cincinnati, OH 45264-3398
Phone (513) 221-1100

Other identifiers 1

IdentifierTypeStateIssuer
2328734MedicaidOH

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20100211000311 OH Practitioner - Nurse Practitioner 9931242070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as apm
Quality
86.02
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1097793KYMDRegistered Nurse
RN.178465-1OHMDRegistered Nurse
COA.06624-NPOHMDAcute Care Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: sbasham@1241.direct.myezyaccess.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458518400000",
    "number": "1194758029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 643398",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452643398",
            "telephone_number": "513-221-1100",
            "fax_number": "513-569-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 THOMAS MORE PKWY",
            "address_2": "SUITE 160",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410175465",
            "telephone_number": "513-221-1100",
            "fax_number": "513-569-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASHAM",
        "first_name": "DALLAS",
        "middle_name": "SCOTT",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2016-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "COA.06624-NP",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3003742",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OH",
            "license": "COA.06624-NP",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "KY",
            "license": "3003742",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.178465-1",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1097793",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2328734",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

Verify at the official NPI Registry.