Bradley S Basham, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002201 Issued in IN

Practice address

1515 E Paulding Rd
Fort Wayne, IN 46816-1252

Phone

(260) 744-2273

Fax

(260) 744-4555

NPI assigned

Sep 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Indiana University - School of Optometry, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mitchell Reinholt OD LLCGroup PAC ID 2264858588, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mitchell Reinholt, OD, LLC

  • Optometrist
  • Warsaw, IN
  • NPI 1952936973
  Medicare reassignment Care Compare group NPD
• Midwest Eye Consultants, P.C.

  • Ophthalmology Physician
  • Fort Wayne, IN
  • NPI 1912960535
  Medicare reassignment NPD
• Midwest Eye Consultants P.C.

  • Optometrist
  • Crown Point, IN
  • NPI 1134641202
  NPD (past)

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433894400000",
    "number": "1477547628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E PAULDING RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468161252",
            "telephone_number": "260-744-2273",
            "fax_number": "260-744-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E PAULDING RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468161252",
            "telephone_number": "260-744-2273",
            "fax_number": "260-744-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASHAM",
        "first_name": "BRADLEY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2015-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100053350",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100053350A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Bartock
• Matthew Tyler Bartock, D.O
• Lyric Barva-McCarty, RBT
• Kayla Bary, MA, BCBA
• Hazel Nalyn Basa, COTA
• Devin Bashore, PHARMD
• Lutfullah Baskoy, MD
• Lacey Bass
• Phillip Bassett
• Taya L Bassett, RBT

• Optometrist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.