Jacqueline Khristen Basham, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Shelbyville, KY
NPI 1396709671 · NPPES record last updated Aug 21, 2014
Key facts
- NPI
- 1396709671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 30475 (KY)
- Practice address
- 140 Stonecrest Rd
Shelbyville, KY 40065-8142 - Phone
- (502) 633-0094
- Fax
- (502) 633-0033
- NPI assigned
- Apr 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- University of Louisville School of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Obhg Kentucky PSC
Practice addresses (Care Compare)
2201 Lexington Ave
Ashland, KY 41101-2843
Phone (800) 967-2289
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120209000670 | KY | Practitioner - Obstetrics/Gynecology | 7719144310 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30475 | KY | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Obhg Kentucky, P.S.C. | Obstetrics & Gynecology | Current |
Accepting new patients |
| East End OBGYN | Obstetrics & Gynecology | Past | Accepting new patients |
Locations
2201 Lexington Ave
Ashland, KY 41101
Phone (606) 268-2560
150 N Eagle Creek Dr
Lexington, KY 40509
Phone (859) 267-9773
1201 Pleasant Valley Rd
Owensboro, KY 42303
Phone (270) 417-2000
4000 Kresge Way
St Matthews, KY 40207
Phone (502) 459-7902
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 30475 | KY | Yes |
Addresses
Primary practice location
140 Stonecrest Rd
Shelbyville, KY 40065-8142
Mailing address
PO Box 950248
Louisville, KY 40295-0248
Phone (502) 253-1035
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000204606 | Other | KY | ANTHEM |
| 000000204621 | Other | KY | ANTHEM |
| 64304751 | Medicaid | KY |
Other providers in Shelbyville, KY
- Jean R Barlow
- Rachel Barnes
- Anna Elizabeth Barrickman
- Julie M Barry
- Camille Basham
- Alexa Rae Baskin
- Anna Kate Bastin
- Elaine M Baunach-Peers
- Cindy Lynn Bayes
- BC Counseling Group
All providers in Shelbyville, KY · Obstetrics & Gynecology Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.