Sreenivasa Basavanthappa, MD

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

License

03-6163408 Issued in IL

Practice address

2501 E College Ave Ste B
Bloomington, IL 61704-2484

Phone

(309) 557-8666

Fax

(309) 827-8027

NPI assigned

Jul 6, 2007

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 1

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Ophthalmology

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gailey Eye Clinic, LTDGroup PAC ID 2769469337, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127

Merit-based Incentive Payment System (MIPS)

Final score

83.19 of 100Reported as group

Quality

99.36

Improvement activities

40

Cost

44.82

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sreenivasa.basavanthappa.p1@direct.clemsoneye.nextgenshare.com
• Direct secure messaging: sreeni.basa.p1@direct.gec.nextgenshare.com

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.

• Gailey Eye Clinic, LTD

  • Ophthalmic Technician/Technologist
  • Forsyth, IL
  • NPI 1184829814
  Medicare reassignment Care Compare group NPD
• Gailey Eye Clinic, LTD

  • Ophthalmic Technician/Technologist
  • Peoria, IL
  • NPI 1275738908
  NPD
• Gailey Eye Clinic, LTD

  • Ophthalmic Technician/Technologist
  • Bloomington, IL
  • NPI 1932156445
  NPD
• Clemson Eye, PA

  • Optometrist
  • Clemson, SC
  • NPI 1790939254
  NPD (past)

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

• Carle Bromenn Medical Center

  • General Acute Care Hospital
  • Normal, IL
  • NPI 1962424036
  Care Compare affiliation

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

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1497953871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 N MAIN ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617011784",
            "telephone_number": "309-557-8666",
            "fax_number": "309-661-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 E COLLEGE AVE STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042484",
            "telephone_number": "309-557-8666",
            "fax_number": "309-827-8027"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "322 W Marion Ave",
            "address_purpose": "LOCATION",
            "city": "Forsyth",
            "state": "IL",
            "postal_code": "625351064",
            "country_code": "US",
            "telephone_number": "217-872-7404",
            "fax_number": "217-872-7432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BASAVANTHAPPA",
        "first_name": "SREENIVASA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-06",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "IL",
            "license": "03-6163408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110096239A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dariell K Barnes
• Seth Thomas Barnett, DMD
• Barry Slotky, M.D., S.C.
• Nicholas David Bartelsmeyer, PA-C
• Meagan Bartley
• Tonya Lynn Bassett, MSW, CADC
• Aneetam Bassi, DDS
• Jacqueline Denise Battle
• Samantha Bauer Delgado
• Richard K Bauersfeld, PT

• Retina Specialist (Ophthalmology) Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Retina Specialist (Ophthalmology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.