Active NPI
Blake Bassett, DO
- General Practice Physician
- Coronado, CA
National Provider Identifier
1225617657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0102207484
- Practice address
- Naval Air Station North Island
28-64 S R Ave
Coronado, CA 92118 - Phone
- (619) 545-6210
- NPI assigned
- Apr 4, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0102207484 | VA | Primary |
Addresses
Primary practice location
Naval Air Station North Island
28-64 S R Ave
Coronado, CA 92118
Mailing address
Naval Air Station North Island
28-64 S R Ave
Coronado, CA 73003
Phone (619) 545-6210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1 | Other | N/A |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | blake.a.bassett.mil@health.mil |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102207484 | VA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681430400000",
"number": "1225617657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "NAVAL AIR STATION NORTH ISLAND",
"address_2": "28-64 S R AVE",
"city": "CORONADO",
"state": "CA",
"postal_code": "73003",
"telephone_number": "619-545-6210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVAL AIR STATION NORTH ISLAND",
"address_2": "28-64 S R AVE",
"city": "CORONADO",
"state": "CA",
"postal_code": "92118",
"telephone_number": "619-545-6210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASSETT",
"first_name": "BLAKE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-04",
"last_updated": "2023-04-14",
"certification_date": "2023-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0102207484",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "N/A",
"identifier": "1",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "blake.a.bassett.mil@health.mil",
"affiliation": "N",
"address_1": "Naval Air Station North Island",
"address_2": "28-64 S R Ave",
"city": "Coronado",
"state": "CA",
"country_code": "US",
"postal_code": "92118",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Coronado, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.