Individual
DR. JARED CHRISTOPHER BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7910 E WASHINGTON ST STE 200, INDIANAPOLIS, IN 46219-5563
(317) 355-7171
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 355-6780
(317) 355-9027
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01060886A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000485636
ANTHEM PIN #
IN
01
—
200311740A
MEDICAID GROUP #
IN
05
—
200826660
—
IN
01
—
7372817
AETNA PIN #
IN
01
—
P00458712
MEDICARE RAILROAD #
IN
01
—
P01014119
RR MEDICARE PTAN
IN
Enumeration date
03/25/2006
Last updated
01/05/2026
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