Bashyam Iyengar, MD
Individual provider Active NPI Family Medicine Physician · Jacksonville, FL
NPI 1205137403 · NPPES record last updated May 22, 2014
Key facts
- NPI
- 1205137403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ME110643 (FL)
- Practice address
- 1760 Edgewood Ave W Ste B
Suite B
Jacksonville, FL 32208-7209 - Phone
- (904) 358-8480
- Fax
- (904) 358-8460
- NPI assigned
- Nov 4, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Vincents Medical Center Inc
Practice addresses (Care Compare)
2627 Riverside Ave
Jacksonville, FL 32204-4712
Phone (904) 308-7372
Hospital & facility affiliations
- Ascension St Vincent'S Riverside
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20130326000421 | FL | Practitioner - Family Practice | 1456532779 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA08303600 | NJ | MD | Family Medicine Physician |
| 255281-1 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Vincents Medical Center Inc | Current |
Accepting new patients | |
| St Vincents Medical Center Inc | Current |
Accepting new patients |
Locations
2627 Riverside Ave
Jacksonville, FL 32204
Phone (904) 308-7372
Interoperability endpoints
- bashyam.iyengar.2@8967.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME110643 | FL | Yes |
| Family Medicine Physician | 207Q00000X | 25MA08303600 | NJ | |
| Family Medicine Physician | 207Q00000X | 255281-1 | NY | |
| Family Medicine Physician | 207Q00000X | MD60189759 | WA |
Addresses
Primary practice location
1760 Edgewood Ave W Ste B
Suite B
Jacksonville, FL 32208-7209
Mailing address
1760 Edgewood Ave W Ste B
Suite B
Jacksonville, FL 32208-7209
Phone (904) 358-8480
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008479700 | Medicaid | FL | |
| 003130827A | Medicaid | GA | |
| 14P8Z | Other | FL | BCBS |
Other providers in Jacksonville, FL
- Paul Ivory
- Ivps of Jacksonsonville
- Jeremy David Ivy
- Nadia Iwanyshyn
- Amanda Iway
- Shreya Iyengar
- Olatunbosun Modupe Iyewarun
- Catherine E Iyoha-Idiong
- Walter John Izarra
- Lauren Izquierdo
All providers in Jacksonville, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2014. 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.