Individual provider Active NPI

Gregory J. Bahder, M.D.

  • Psychiatry Physician
  • Medical Lake, WA
National Provider Identifier
1649370644
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ML60600742 Issued in WA
Practice address
850 Maple Street
Medical Lake, WA 99022-0800
Phone
(509) 565-4000
Fax
(509) 565-4705
NPI assigned
Sep 22, 2006
Last updated
Nov 18, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 10739 NH
Psychiatry Physician 2084P0800X ML60600742 WA Primary

Addresses

Primary practice location

850 Maple Street
Medical Lake, WA 99022-0800

Mailing address

PO Box 800
Medical Lake, WA 99022-0800
Phone (509) 565-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20151105002644 WA Practitioner - Psychiatry 8921021841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Department of Social Dept of SHS Div of InstnsGroup PAC ID 9133013725, 23 clinicians

Practice addresses (Care Compare)

850 Maple St
Medical Lake, WA 99022-0800
Phone (509) 565-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
10739NHMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Department of Social Dept of SHS Div of Instns Psychiatry CurrentSince Oct 5, 2015 Accepting new patients
Department of Social Past Accepting new patients
Eastern State Hospital Pharmacy PastSince Oct 5, 2015 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1649370644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 MAPLE STREET",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAHDER",
        "first_name": "GREGORY",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NH",
            "license": "10739",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "ML60600742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medical Lake, WA

Sources for this page

Verify at the official NPI Registry.