Individual provider Active NPI

Renee Marie Bassaly, D.O.

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Tampa, FL
National Provider Identifier
1235399130
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
OS10371 Issued in FL
Practice address
3617 W Hamilton Ave
Tampa, FL 33614-4055
Phone
(813) 467-4265
Fax
(813) 467-4267
NPI assigned
Jun 13, 2008
Last updated
Aug 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X OS10371 FL
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X OS10371 FL Primary

Addresses

Primary practice location

3617 W Hamilton Ave
Tampa, FL 33614-4055

Mailing address

3617 W Hamilton Ave
Tampa, FL 33614-4055
Phone (813) 467-4265

Other identifiers 1

IdentifierTypeStateIssuer
003665900MedicaidFL

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20110707000571 FL Practitioner - Obstetrics/Gynecology 2365620747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Philadelphia College of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Florida Hospital Physician Group IncGroup PAC ID 2365679057, 953 clinicians

Practice addresses (Care Compare)

13901 Bruce B Downs Blvd
Tampa, FL 33613-3905
Phone (813) 615-7260

6919 N Dale Mabry Hwy
Suite 200
Tampa, FL 33614-3972
Phone (813) 933-3324

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS10371FLMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Physician Group Inc Obstetrics & Gynecology CurrentSince Aug 28, 2021 Accepting new patients
Florida Hospital Physician Group Inc Obstetrics & Gynecology CurrentSince Aug 16, 2021 Accepting new patients
University Medical Service Association Inc Past Accepting new patients

Locations

13901 Bruce B Downs Blvd
Tampa, FL 33613
Phone (813) 615-7260

3617 W Hamilton Ave
Tampa, FL 33614
Phone (813) 467-4265

6919 N Dale Mabry Hwy
Ste 300
Tampa, FL 33614
Phone (813) 935-3221

2700 Healing Way
Ste 310
Wesley Chapel, FL 33543
Phone (813) 779-1209

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: rbassaly73453@adventhealth.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1235399130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3617 W HAMILTON AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336144055",
            "telephone_number": "813-467-4265",
            "fax_number": "813-467-4267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 W HAMILTON AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336144055",
            "telephone_number": "813-467-4265",
            "fax_number": "813-467-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASSALY",
        "first_name": "RENEE",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-13",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "OS10371",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "FL",
            "license": "OS10371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003665900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.