Provider Demographics
NPI:1316907009
Name:BASHAM, JARED CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:CHRISTOPHER
Last Name:BASHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-355-6780
Mailing Address - Fax:317-355-9027
Practice Address - Street 1:9015 E 17TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2016
Practice Address - Country:US
Practice Address - Phone:317-355-7700
Practice Address - Fax:317-355-9027
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060886A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200826660Medicaid
IN7372817OtherAETNA PIN #
IN000000485636OtherANTHEM PIN #
INP00458712OtherMEDICARE RAILROAD #
INP01014119OtherRR MEDICARE PTAN
IN200311740AOtherMEDICAID GROUP #
IN200826660Medicaid
IN205110HHMedicare Oscar/Certification
INM400037713Medicare PIN
INM400037708Medicare PIN
INM400037717Medicare PIN
INM400030024Medicare PIN
IN200311740AOtherMEDICAID GROUP #
INP00458712OtherMEDICARE RAILROAD #
INI70244Medicare UPIN
INM400037680Medicare PIN