Individual provider Active NPI

Pamela Basas Malda, NP

  • Nurse Practitioner
  • Wauconda, IL
National Provider Identifier
1891238200
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209015216 Issued in IL
Practice address
431 W Liberty St
Wauconda, IL 60084
Phone
(847) 526-2151
Fax
(847) 526-2017
NPI assigned
Dec 2, 2016
Last updated
Mar 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209015216 IL Primary

Addresses

Primary practice location

431 W Liberty St
Wauconda, IL 60084

Mailing address

PO Box 6037
Wauconda, IL 60084-6037
Phone (847) 526-2151

Other names 1

  • Ms. Pamela Basas Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161208001092 IL Practitioner - Nurse Practitioner 1557641529 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vitae Health Medical Illinois, PLLCGroup PAC ID 2365798410, 214 clinicians

Practice addresses (Care Compare)

2732 N Hampden CT
Chicago, IL 60614-1612
Phone (773) 248-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Illinois, PLLC CurrentSince Jul 1, 2020 Accepting new patients
Northwest Suburban Medical Group S.C CurrentSince Feb 1, 2020 Accepting new patients

Locations

2732 N Hampden Ct
Chicago, IL 60614
Phone (773) 248-6000

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

2201 W Schaumburg Rd
#B
Schaumburg, IL 60194
Phone (847) 885-8480

3450 Oakton St
Ste 300
Skokie, IL 60076

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CGCFBD

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1891238200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6037",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "600846037",
            "telephone_number": "847-526-2151",
            "fax_number": "847-526-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 W LIBERTY ST",
            "city": "WAUCONDA",
            "state": "IL",
            "postal_code": "60084",
            "telephone_number": "847-526-2151",
            "fax_number": "847-526-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASAS MALDA",
        "first_name": "PAMELA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-02",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209015216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "BASAS",
            "prefix": "MS.",
            "credential": "APN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wauconda, IL

Sources for this page

Verify at the official NPI Registry.