Active NPI
Gilles Bastille, M.D.
- Family Medicine Physician
- Ft Payne, AL
National Provider Identifier
1790798346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 00009111
- Practice address
- 1040 Glenn Blvd SW
Ft Payne, AL 35967-8413 - Phone
- (256) 845-6900
- Fax
- (256) 845-6911
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 00009111 | AL | Primary |
Addresses
Primary practice location
1040 Glenn Blvd SW
Ft Payne, AL 35967-8413
Mailing address
1040 Glenn Blvd SW
Ft Payne, AL 35967-8413
Phone (256) 845-6900
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00009111 | AL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790798346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 GLENN BLVD SW",
"city": "FT PAYNE",
"state": "AL",
"postal_code": "359678413",
"telephone_number": "256-845-6900",
"fax_number": "256-845-6911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 GLENN BLVD SW",
"city": "FT PAYNE",
"state": "AL",
"postal_code": "359678413",
"telephone_number": "256-845-6900",
"fax_number": "256-845-6911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASTILLE",
"first_name": "GILLES",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AL",
"license": "00009111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Payne, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.