Active NPI
Bass Medical Group
- Orthopaedic Surgery Physician
- Pleasanton, CA
National Provider Identifier
1396434676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- Legal business name
- BASS MEDICAL GROUP
- Practice address
- 4626 Willow Rd Ste 200
Pleasanton, CA 94588-8564 - Phone
- (925) 463-0470
- NPI assigned
- May 3, 2023
- Last updated
- Jul 11, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Inez Wondeh
- Title
- Ceo
- Phone
- (925) 948-8143
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | |||
| Orthopaedic Surgery Physician | 207X00000X | Primary |
Addresses
Primary practice location
4626 Willow Rd Ste 200
Pleasanton, CA 94588-8564
Mailing address
2637 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone (925) 627-3424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231030003100 | CA | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 9032111281 | Practice locations: Pleasanton, CA |
Other NPIs with the same Medicare PAC ID 12
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683072000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1689033600000",
"number": "1396434676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2637 SHADELANDS DR",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945982512",
"telephone_number": "925-627-3424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4626 WILLOW RD STE 200",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945888564",
"telephone_number": "925-463-0470"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BASS MEDICAL GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2023-05-03",
"last_updated": "2023-07-11",
"certification_date": "2023-07-11",
"status": "A",
"authorized_official_last_name": "WONDEH",
"authorized_official_first_name": "INEZ",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "925-948-8143"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.