Kimberly Susan Bass, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

34550 Issued in MN

Practice address

1347 Larpenteur Ave W
Falcon Heights, MN 55113-6302

Phone

(651) 558-2020

Fax

(651) 487-2369

NPI assigned

Oct 27, 2006

Last updated

Feb 19, 2009By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235001600000",
    "number": "1801972674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1347 LARPENTEUR AVE W",
            "city": "FALCON HEIGHTS",
            "state": "MN",
            "postal_code": "551136302",
            "telephone_number": "651-558-2020",
            "fax_number": "651-487-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1347 LARPENTEUR AVE W",
            "city": "FALCON HEIGHTS",
            "state": "MN",
            "postal_code": "551136302",
            "telephone_number": "651-558-2020",
            "fax_number": "651-487-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASS",
        "first_name": "KIMBERLY",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2009-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "34550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00375969",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Falcon Heights, MN
• Providers in Falcon Heights, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; 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.