Individual provider Active NPI

Bonnie N. Basler, MD

  • Family Medicine Physician
  • Tupelo, MS
National Provider Identifier
1851398309
Registry record updated Mar 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101235038 Issued in VA
Practice address
3411 W Main St
Tupelo, MS 38801-9413
Phone
(662) 844-9376
Fax
(662) 844-4326
NPI assigned
Jun 30, 2005
Last updated
Mar 24, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101235038 VA Primary

Addresses

Primary practice location

3411 W Main St
Tupelo, MS 38801-9413

Mailing address

3411 W Main St
Tupelo, MS 38801-9413
Phone (662) 844-9376

Other identifiers 4

IdentifierTypeStateIssuer
420016OtherVACOVENTRY HEALTH
010028914MedicaidVA
298379OtherVASOUTHERN HEALTH
104944OtherVAANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20091130000245 MS Practitioner - Family Practice 6406843259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3411 W Main St
Tupelo, MS 38801-9413
Phone (662) 844-9376

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Clinics Inc Family Medicine CurrentSince Oct 1, 2009 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medical Clinics Inc CurrentSince Oct 1, 2009 Accepting new patients

Locations

3411 W Main St
Tupelo, MS 38801
Phone (662) 844-9376

844 S Madison St
Tupelo, MS 38801
Phone (662) 377-5400

845 S Madison St
Tupelo, MS 38801
Phone (601) 790-5025

Interoperability endpoints

  • Direct secure messaging: bonniebalser@nmhs.medalliesdirect.net

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300924800000",
    "number": "1851398309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411 W MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388019413",
            "telephone_number": "662-844-9376",
            "fax_number": "662-844-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 W MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388019413",
            "telephone_number": "662-844-9376",
            "fax_number": "662-844-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASLER",
        "first_name": "BONNIE",
        "middle_name": "N.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-30",
        "last_updated": "2011-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101235038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HEALTH",
            "identifier": "420016",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010028914",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "298379",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "104944",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.