Individual provider Active NPI

Bassam George Hadeed, MD

  • Pediatrics Physician
  • Clackamas, OR
National Provider Identifier
1457397176
Registry record updated Nov 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD19473 Issued in OR
Practice address
8645 SE Sunnybrook Blvd Ste 200
Clackamas, OR 97015-6841
Phone
(503) 659-1694
Fax
(503) 659-8984
NPI assigned
Jun 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD19473 OR Primary

Addresses

Primary practice location

8645 SE Sunnybrook Blvd Ste 200
Clackamas, OR 97015-6841

Mailing address

8645 SE Sunnybrook Blvd Ste 200
Clackamas, OR 97015-6841
Phone (503) 659-1694

Other identifiers 1

IdentifierTypeStateIssuer
139497MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jul 23, 2020 through Jul 23, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD19473ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Pediatrics NE Portland PC Pediatrics Past Accepting new patients
Rupa K. Shah, MD, PC Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: bhadeed9702@direct.lhs.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573603200000",
    "number": "1457397176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8645 SE SUNNYBROOK BLVD STE 200",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156841",
            "telephone_number": "503-659-1694",
            "fax_number": "503-659-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8645 SE SUNNYBROOK BLVD STE 200",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156841",
            "telephone_number": "503-659-1694",
            "fax_number": "503-659-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADEED",
        "first_name": "BASSAM",
        "middle_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2019-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD19473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "139497",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

Verify at the official NPI Registry.