Individual provider Active NPI

Basit G. Nisbeth, DDS

  • Dentist
  • Homewood, IL
National Provider Identifier
1265663157
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019-022628 Issued in IL
Practice address
2421 183Rd St
Homewood, IL 60430-3120
Phone
(708) 917-5041
Fax
(708) 365-6184
NPI assigned
Jul 27, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019-022628 IL Primary
General Practice Dentistry 1223G0001X 019-022628 IL

Addresses

Primary practice location

2421 183Rd St
Homewood, IL 60430-3120

Mailing address

18430 S Halsted St
Glenwood, IL 60425-1013
Phone (708) 755-7605

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191226002271 AL Practitioner - Dentist 2264866201 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-022628ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Franklin Primary Health Center, Inc CurrentSince Oct 22, 2019 Accepting new patients
Franklin Primary Health Center Inc. Dentist CurrentSince Oct 22, 2019 Accepting new patients

Locations

1303 Dr Martin L King Jr Ave
Mobile, AL 36603
Phone (251) 436-7646

1303 Dr Martin L King Jr Ave
#A
Mobile, AL 36603

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1265663157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18430 S HALSTED ST",
            "city": "GLENWOOD",
            "state": "IL",
            "postal_code": "604251013",
            "telephone_number": "708-755-7605",
            "fax_number": "708-755-7616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 183RD ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604303120",
            "telephone_number": "708-917-5041",
            "fax_number": "708-365-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISBETH",
        "first_name": "BASIT",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-27",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-022628",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-022628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homewood, IL

Sources for this page

Verify at the official NPI Registry.