BIJAN BASTANINEJAD (NPI# 1972589968) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972589968 |
| Entity Type | Individual |
| Full Name | BIJAN BASTANINEJAD |
| Credential | M.D. |
| Practice Address |
2620 N Westwood Blvd Poplar Bluff MO 63901-3396 |
| Practice Telephone | 5737857721 |
| Practice Fax Number | 5737272465 |
| Mailing Telephone | 5737857721 |
| Mailing Fax Number | 5737272465 |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-09-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 237324 | NY | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | 2009039681 | MO | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 35.088489 | OH | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | 35.088489 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | AETNA | 7210867 | 01 |
| MI | 5202199 | 05 | |
| NY | BLUECROSS BLUESHIELD | 237324 | 01 |
| OH | PARAMOUNT | 05227 | 01 |
| MI | HPM | 40113 | 01 |
| MI | 4920459 | 05 | |
| OH | ANTHEM | 000000488786 | 01 |
| NY | 02695054 | 05 | |
| OH | 2678446 | 05 | |
| OH | ANTHEM | 000000520832 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3100 Oak Grove Rd, Poplar Bluff, MO 639011573 | 5737762000 | |
| 610 N One Mile Rd, Dexter, MO 638412539 | 5736243600 |
| Street Address |
2620 N WESTWOOD BLVD |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-3396 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063944932 | Michelle Heath | Nurse Practitioner | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2017-03-30 |
| 1558605873 | Rachel Jean Smith | Nurse Practitioner | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2012-11-27 |
| 1770851743 | Lisa Renee Carroll | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2011-12-06 |
| 1053699975 | Christopher Muiruri Kahuho | Hospitalist | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2011-07-26 |
| 1811293756 | Amy Michelle Pennington | Nurse Practitioner | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2011-02-09 |
| 1841592524 | Ozark Emergency Group LLC | Physician Assistant | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2010-12-01 |
| 1548562531 | Candice Leigh Copeland | Nurse Practitioner | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2010-11-23 |
| 1699080143 | Southeast Missouri Anesthesia Partners LLC | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2010-08-09 |
| 1780903021 | Charles Matthew Hollis | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2010-05-26 |
| 1538482260 | Barbara Mcmains | Nurse Practitioner | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2010-03-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023574365 | Saint Francis Medical Center | Pediatrics | 2210 Barron Rd Ste 120, Poplar Bluff, MO 63901-1908 | 2019-02-12 |
| 1609037381 | Children's Clinic | Pediatrics | 2500 Lucy Lee Pkwy, Poplar Bluff, MO 63901-2436 | 2008-06-24 |
| 1467424416 | Rangsan Suvan | Pediatrics | 2500 Lucy Lee Parkway, Poplar Bluff, MO 63901 | 2006-02-03 |
| 1982056545 | Butler Physician Services, LLC | Pediatrics | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2016-07-07 |
| 1932515954 | Poplar Bluff Regional Medical Center, LLC | Pediatrics | 2360 Katy Ln, Poplar Bluff, MO 63901-2300 | 2014-07-10 |
| 1811057565 | Rebecca J Pinchoff | Pediatrics | 686 Lester St, Poplar Bluff, MO 63901-5025 | 2006-12-11 |
| 1669559605 | Joseph P Fernando | Pediatrics | 2340 Katy Ln, Suite 120, Poplar Bluff, MO 63901-2300 | 2006-11-01 |
| 1538246624 | Claudia Karin Preuschoff | Pediatrics | 2210 Barron Rd, Suite 120, Poplar Bluff, MO 63901-1908 | 2006-11-01 |
| 1568549699 | Debra Ann Robertson | Pediatrics | 2210 Barron Rd, 120, Poplar Bluff, MO 63901-1908 | 2006-11-01 |
| 1215949599 | Derry Dean Dye Jr. | Pediatrics | 2210 Barron Rd, Suite 120, Poplar Bluff, MO 63901-1908 | 2006-08-13 |
| Find all providers in POPLAR BLUFF | ||||
| City | POPLAR BLUFF |
| Zip Code | 63901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.