NPIMap

Individual provider Active NPI

Fawn Bass

  • Pharmacist
  • Stevensville, MI
National Provider Identifier
1770170193
Registry record updated Dec 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5315122181 Issued in MI
Practice address
5637 Cleveland Ave
Stevensville, MI 49127-9613
Phone
(269) 429-8441
Fax
(269) 429-7578
NPI assigned
Dec 31, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5315122181 MI Primary

Addresses

Primary practice location

5637 Cleveland Ave
Stevensville, MI 49127-9613

Mailing address

8745 Hollywood Rd
Berrien Springs, MI 49103-9104
Phone (269) 449-2110

Other identifiers 1

IdentifierTypeStateIssuer
227434OtherNABP PERSONAL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address st23rx@martins-supermarkets.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5315122181MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Martin's Super Markets of Stevensville LLC PastSince Jan 3, 2021 Accepting new patients

Organizations & group practices 1

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": "1609372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1770170193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8745 HOLLYWOOD RD",
            "city": "BERRIEN SPRINGS",
            "state": "MI",
            "postal_code": "491039104",
            "telephone_number": "269-449-2110",
            "fax_number": "269-429-7578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5637 CLEVELAND AVE",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491279613",
            "telephone_number": "269-429-8441",
            "fax_number": "269-429-7578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASS",
        "first_name": "FAWN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-31",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5315122181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP PERSONAL",
            "identifier": "227434",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "st23rx@martins-supermarkets.com",
            "affiliation": "N",
            "endpointDescription": "practice location email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "5637 Cleveland Ave",
            "city": "Stevensville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "491279613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stevensville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.