Individual provider Active NPI

Katherina Kobraei Basic, MD

  • Dermatology Physician
  • Gainesville, FL
National Provider Identifier
1457448342
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME105569 Issued in FL
Practice address
1601 SW Archer Rd
Gainesville, FL 32608-1197
Phone
(352) 337-4900
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X ME105569 FL Primary

Addresses

Primary practice location

1601 SW Archer Rd
Gainesville, FL 32608-1197

Mailing address

1601 SW Archer Rd
Gainesville, FL 32608-1135
Phone (352) 337-4900

Other identifiers 1

IdentifierTypeStateIssuer
002471100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100914000144 FL Practitioner - Dermatology 7315062445 Reassigns benefits to 1 organization
I20170523000510 NH Practitioner - Dermatology 7315062445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Wright State University Boonshoft School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology of Gainesville LLCGroup PAC ID 7618211061, 8 clinicians

Practice addresses (Care Compare)

410 N Main St
Suite 9
Chiefland, FL 32626-0866
Phone (352) 260-0170

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions53
Removal or shaving of skin growth1-10
Skin biopsy31

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME105569FLMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology of Gainesville LLC Dermatology CurrentSince Jan 1, 2023 Accepting new patients
Dartmouth-Hitchcock Clinic Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
U-U Pediatric Dermatology PastSince May 24, 2020 Accepting new patients

Locations

410 N Main St
Ste 9
Chiefland, FL 32626
Phone (352) 260-0170

13575 NW 1st Ln
Ste 10
Newberry, FL 32669
Phone (352) 260-0170

315 NW 138th Ter
Newberry, FL 32669
Phone (352) 443-0353

590 Court St
Keene, NH 03431
Phone (603) 354-5454

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

Organizations & group practices 3

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1457448342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326081135",
            "telephone_number": "352-337-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326081197",
            "telephone_number": "352-337-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASIC",
        "first_name": "KATHERINA",
        "middle_name": "KOBRAEI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-06-23",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME105569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002471100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.