Nisha Ann Basu, MD
Individual provider Active NPI Internal Medicine Physician · Watertown, MA
NPI 1790723310 · NPPES record last updated Jul 1, 2024
Key facts
- NPI
- 1790723310
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 211506 (MA)
- Practice address
- 101 Walnut St
Watertown, MA 02472-4054 - Phone
- (888) 897-1887
- NPI assigned
- Jun 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070706000423 | MA | Practitioner - Internal Medicine | 4587764402 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 211506 | MA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc | Current |
Accepting new patients | |
| Beth Israel Deaconess Medical Center, Inc. | Current |
Accepting new patients | |
| Beth Israel Deaconess Medical Center, Inc. | Current |
Accepting new patients | |
| Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc | Internal Medicine | Current |
Accepting new patients |
Locations
330 Brookline Ave
Fl 1
Boston, MA 02215
330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 211506 | MA | Yes |
Addresses
Primary practice location
101 Walnut St
Watertown, MA 02472-4054
Mailing address
330 Brookline Avenue
Boston, MA 02215
Phone (617) 667-9600
Other practice location 1
330 Brookline Ave
1st Floor, Atrium Suite
Boston, MA 02215-5400
Phone (617) 667-9600
Other providers in Watertown, MA
- Barry J Agranat DMP PC
- Scott Patrick Barry
- Lauren Samantha Basile
- Olivia Bass
- Leon B Bastajian
- Mark R Bauer
- Edward V. Bauman
- Bay State Urologists Inc
- Beaverbrook Step, Inc.
- Margaret Ann Beck
All providers in Watertown, MA · Internal Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.