Individual provider Active NPI

Anam Bashir, M.D.

  • Pediatric Gastroenterology Physician
  • Philadelphia, PA
National Provider Identifier
1366975930
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
MD480353 Issued in PA
Practice address
3401 Civic Center Blvd Division of Pediatric Nutrition
Philadelphia, PA 19104-4874
Phone
(267) 425-2739
NPI assigned
Apr 10, 2017
Last updated
Jun 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 72699-20 WI
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Gastroenterology Physician 2080P0206X MD480353 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd Division of Pediatric Nutrition
Philadelphia, PA 19104-4874

Mailing address

3401 Civic Center Blvd Division of Pediatric Nutrition
Philadelphia, PA 19104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20240802001405 PA Practitioner - Gastroenterology 2567737406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3401 Civic Ctr Blvd
Philadelphia, PA 19104-4319
Phone (215) 590-1000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
72699-20WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Childen's Health Care Associates Inc. CurrentSince Jul 1, 2024 Accepting new patients
Childrens Health Care Associates, Inc Pediatric Gastroenterology CurrentSince Jul 1, 2024 Accepting new patients
Childrens Health Care Associates of New Jersey PC Pediatrics Past Accepting new patients

Locations

2929 Arch St
Fl 12
Philadelphia, PA 19104

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

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.

NPI Registry JSON

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1366975930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC NUTRITION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC NUTRITION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044874",
            "telephone_number": "267-425-2739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASHIR",
        "first_name": "ANAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-10",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "72699-20",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "PA",
            "license": "MD480353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.