Active NPI
Mark A Basham, MD
- Family Medicine Physician
- Eureka, KS
National Provider Identifier
1255326443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0428069
- Practice address
- 110 E 16TH St
Eureka, KS 67045-1067 - Phone
- (620) 583-7451
- Fax
- (620) 583-6702
- NPI assigned
- Sep 14, 2005
- Last updated
- Nov 29, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0428069 | KS | Primary |
Addresses
Primary practice location
110 E 16TH St
Eureka, KS 67045-1067
Mailing address
110 E 16TH St
Eureka, KS 67045-1067
Phone (620) 583-7451
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100362190B | Medicaid | KS | |
| 178960 | Other | RURAL HEALTH MEDICARE | |
| 640311 | Other | F. GUARD | |
| 100428860A | Other | GROUP MEDICAID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Nebraska College of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
100 W
16TH
Eureka, KS 67045
100 W 16TH St
Eureka, KS 67045-1064
Phone (620) 583-5274
100 W 16TH St
Eureka, KS 67045-1096
311 Main St
Eureka, KS 67045
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0428069 | KS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greenwood County Hospital | Past | Accepting new patients | |
| Eureka Nursing, LLC | Past | Accepting new patients | |
| Greenwood County Hospital | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- mark.basham.1@12044.direct.athenahealth.com
Organizations & group practices 4
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.
-
- Skilled Nursing Facility
- Eureka, KS
- NPI 1730354564
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Community Based Hospice Care Agency
- Wichita, KS
- NPI 1518069673
-
- Home Health Agency
- Eureka, KS
- NPI 1275531485
-
- General Acute Care Hospital
- El Dorado, KS
- NPI 1700994977
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701216000000",
"number": "1255326443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 E 16TH ST",
"city": "EUREKA",
"state": "KS",
"postal_code": "670451067",
"telephone_number": "620-583-7451",
"fax_number": "620-583-6702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E 16TH ST",
"city": "EUREKA",
"state": "KS",
"postal_code": "670451067",
"telephone_number": "620-583-7451",
"fax_number": "620-583-6702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASHAM",
"first_name": "MARK",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-14",
"last_updated": "2023-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KS",
"license": "0428069",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100362190B",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RURAL HEALTH MEDICARE",
"identifier": "178960",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "F. GUARD",
"identifier": "640311",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICAID",
"identifier": "100428860A",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Eureka, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; 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.