NPIMap

Individual provider Active NPI

Luke Basdeo, MD

  • Nephrology Physician
  • Port Orange, FL
National Provider Identifier
1427491729
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME127148 Issued in FL
Practice address
1728 Dunlawton Ave Ste 4
Port Orange, FL 32127-2923
Phone
(386) 304-8302
Fax
(386) 304-8204
NPI assigned
Apr 17, 2013
Last updated
Mar 31, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME127148 FL Primary

Addresses

Primary practice location

1728 Dunlawton Ave Ste 4
Port Orange, FL 32127-2923

Mailing address

1728 Dunlawton Ave Ste 4
Port Orange, FL 32127-2923
Phone (386) 304-8302

Other practice location 1

335 Clyde Morris Blvd Ste 260
Ormond Beach, FL 32174-3196
Phone (386) 304-8302

Other identifiers 1

IdentifierTypeStateIssuer
017894400MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address luke.basdeo.1@20431.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160809002193 FL Practitioner - NephrologyPractitioner - Internal Medicine 0547403651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Daytona Beach Nephrology LLCGroup PAC ID 2365874211, 2 clinicians

Practice addresses (Care Compare)

544 Health Blvd
Daytona Beach, FL 32114-1492
Phone (386) 304-8302

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Daytona Beach Nephrology LLC Nephrology CurrentSince Dec 1, 2019 Accepting new patients
Fresenius Medical Care Daytona, LLC PastSince Sep 16, 2021 Accepting new patients

Locations

544 Health Blvd
Daytona Beach, FL 32114
Phone (386) 258-6522

335 Clyde Morris Blvd
Ste 260
Ormond Beach, FL 32174
Phone (386) 672-4001

1728 Dunlawton Ave
Ste 4
Port Orange, FL 32127
Phone (386) 304-8302

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20431/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/HBCFDD/Endpoint/HBCFDD
  • Direct secure messaging: luke.basdeo.1@20431.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1427491729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1728 DUNLAWTON AVE STE 4",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272923",
            "telephone_number": "386-304-8302",
            "fax_number": "386-304-8204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1728 DUNLAWTON AVE STE 4",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272923",
            "telephone_number": "386-304-8302",
            "fax_number": "386-304-8204"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 Clyde Morris Blvd Ste 260",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321743196",
            "country_code": "US",
            "telephone_number": "386-304-8302",
            "fax_number": "386-304-8204",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASDEO",
        "first_name": "LUKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-17",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME127148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017894400",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "luke.basdeo.1@20431.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "1728 Dunlawton Ave Ste 4",
            "city": "Port Orange",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321272923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.