Provider Demographics
NPI:1154401941
Name:BASS MEDICAL GROUP
Entity type:Organization
Organization Name:BASS MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGESETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-932-6330
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2637 SHADELANDS DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2512
Practice Address - Country:US
Practice Address - Phone:925-932-6330
Practice Address - Fax:925-932-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78168174400000X, 174400000X
CAA77948174400000X
CAG32920174400000X
CAG54054174400000X
CAA43945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1208539636OtherNPI
CA1285638015OtherNPI
CA1477655363OtherNPI
CA1689786840OtherNPI
CA1750347100OtherNPI
CA1508803172OtherNPI
CA1346244183OtherNPI
CA1467554337OtherNPI