Shane Bastar, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

20212-130 Issued in WI

Practice address

2357 W Mason St
Green Bay, WI 54303-4708

Phone

(920) 337-6740

NPI assigned

May 31, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Quality Addiction Management Inc

  • Methadone Clinic
  • Kenosha, WI
  • NPI 1184354979
  NPD (past)
• Quality Addiction Management Inc

  • Methadone Clinic
  • Green Bay, WI
  • NPI 1629282470

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1457044000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2357 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034708",
            "telephone_number": "920-337-6740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2357 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034708",
            "telephone_number": "920-337-6740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTAR",
        "first_name": "SHANE",
        "credential": "SAC-IT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "20212-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth J Basak, PT
• Ashlie Basche
• Celestina Bassett, NP
• Kathryn L Bassett, QTT
• Subash Bastakoti, M.D.
• Alesia Bates, MSW, LCSW
• Iffat Batool
• Melissa M Battle, DC
• Bliss A Baudhuin, LPC
• Chad J Baudhuin, MA, MDIV, LPC

• Addiction (Substance Use Disorder) Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.