REDA TAWFIK BASSALY PA-C NPI 1043551930

NPI Information

NPI: 1043551930
Provider Name: REDA TAWFIK BASSALY, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: ICCO LLC

PECOS Registration: Yes

Address:
9800 SE SUNNYSIDE RD
CLACKAMAS, OR
ZIP 97015
Phone: (503) 813-2000
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Reda Tawfik Bassaly, PA-C is a medical physician assistant in Clackamas, OR with 11 years of experience. Reda Tawfik Bassaly, PA-C NPI is 1043551930. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

9800 SE SUNNYSIDE RD
CLACKAMAS, OR
ZIP 97015-750
Phone: (503) 813-2000

The NPI 1043551930 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/3/2013 and was last updated on 12/31/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA163414	OREGON	Yes
2	363A00000X	Physician Assistant		PA163414	OREGON	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500657182	MEDICAID	OREGON
2	2035614	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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