Individual provider Active NPI

Basem Issa

  • Driver
  • San Bernardino, CA
National Provider Identifier
1932866480
Registry record updated Nov 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DriverTaxonomy code 172A00000X
License
C6607310 Issued in CA
Practice address
6444 N Beechwood Ave
San Bernardino, CA 92407-4026
Phone
(909) 520-4542
NPI assigned
Nov 19, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Driver 172A00000X C6607310 CA Primary

Addresses

Primary practice location

6444 N Beechwood Ave
San Bernardino, CA 92407-4026

Mailing address

6444 N Beechwood Ave
San Bernardino, CA 92407-4026
Phone (909) 520-4542

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
C6607310CAMDDriver

Practice roles

OrganizationSpecialtyStatusNew patients
Mission Care Transportation CurrentSince Nov 21, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1932866480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6444 N BEECHWOOD AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924074026",
            "telephone_number": "909-520-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6444 N BEECHWOOD AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924074026",
            "telephone_number": "909-520-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISSA",
        "first_name": "BASEM",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-19",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "CA",
            "license": "C6607310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; 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.