Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.
BIJAN BASTANINEJAD M.D.
Complete NPI Record 1972589968
Pediatrics in Poplar Bluff, MO
Active since December 21, 2005PECOS Enrolled
Complete NPI Dataset
This page contains the complete raw NPPES record for Bijan Bastaninejad, M.D. (NPI 1972589968), an individual pediatrics provider in Poplar Bluff, MO. All 28 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1972589968 Field 1/28
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/28
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: BASTANINEJAD Field 3/28
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: BIJAN Field 4/28
- The first name of the provider, if the provider is an individual.
- Provider Credential Text: M.D. Field 5/28
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 110 S 2ND ST Field 6/28
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: ELLINGTON Field 7/28
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MO Field 8/28
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 636389400 Field 9/28
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 10/28
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 5736632313 Field 11/28
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider Business Mailing Address Fax Number: 5736632441 Field 12/28
- The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
- Provider First Line Business Practice Location Address: 225 PHYSICIANS PARK STE 304 Field 13/28
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: POPLAR BLUFF Field 14/28
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MO Field 15/28
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 639013930 Field 16/28
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 17/28
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 5737275500 Field 18/28
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 5733992646 Field 19/28
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: M Field 22/28
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 208000000X Field 23/28
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: 2009039681 Field 24/28
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: MO Field 25/28
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 26/28
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 27/28
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 29
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
610 N One Mile Rd
Location 1/29Dexter, MO 63841-2539 · Phone (573) 624-3600
3277 US Highway 160 W
Location 2/29Doniphan, MO 63935-5710 · Phone (573) 804-9527 · Fax (573) 804-9536
711 Nickey St
Location 3/29Poplar Bluff, MO 63901-6544 · Phone (573) 785-7047 ext. 13040 · Fax (573) 413-4192
603 E Summit St
Location 4/29Doniphan, MO 63935-1142 · Phone (573) 996-3667 ext. 1117 · Fax (573) 413-4487
225 Physicians Park Ste 104
Location 5/29Poplar Bluff, MO 63901-3918 · Phone (573) 413-4065 · Fax (573) 354-5013
2210 Barron Rd Ste 120
Location 6/29Poplar Bluff, MO 63901-1922 · Phone (573) 785-6536 · Fax (573) 785-0100
225 Physicians Park Ste 200
Location 7/29Poplar Bluff, MO 63901-3921 · Phone (573) 727-5500 ext. 5 · Fax (573) 313-3684
220 East Broad Street
Location 8/29Naylor, MO 63953 · Phone (573) 399-2311 · Fax (573) 399-2076
225 Physicians Park Ste 102
Location 9/29Poplar Bluff, MO 63901-3918 · Phone (573) 727-5500 ext. 2 · Fax (573) 413-4609
2879 James Blvd
Location 10/29Poplar Bluff, MO 63901-3395 · Phone (573) 609-8800 · Fax (573) 776-6124
109 Plum St Ste A
Location 11/29Doniphan, MO 63935-1225 · Phone (573) 351-0150 · Fax (573) 996-2245
109 Plum St Ste B
Location 12/29Doniphan, MO 63935-1225 · Phone (573) 351-0220 · Fax (573) 996-2246
315 W Mulberry Ste A
Location 13/29Pilot Knob, MO 63663-7883 · Phone (573) 546-0602 · Fax (573) 546-0546
1 Hals Plz Ste A
Location 14/29Piedmont, MO 63957-1631 · Phone (573) 223-4800 · Fax (573) 223-7911
61 Highway Y
Location 15/29Ellington, MO 63638-7802 · Phone (573) 663-2525 · Fax (573) 663-7844
202 Allen St
Location 16/29Annapolis, MO 63620-8778 · Phone (573) 598-4213 · Fax (573) 598-1101
109 LeRoux St
Location 17/29Doniphan, MO 63935-1038 · Phone (573) 996-2136 · Fax (573) 996-5216
17959 Main St
Location 18/29Eminence, MO 65466-6375 · Phone (573) 226-5505 · Fax (573) 226-1256
405 Main Street
Location 19/29Van Buren, MO 63965 · Phone (573) 323-4253 · Fax (573) 323-0154
2620 N Westwood Blvd
Location 20/29Poplar Bluff, MO 63901-3396 · Phone (573) 785-7721 · Fax (573) 727-2465
3100 Oak Grove Rd
Location 21/29Poplar Bluff, MO 63901-1573 · Phone (573) 776-2000
101 E Batten Street
Location 22/29Naylor, MO 63953 · Phone (573) 804-1779 · Fax (573) 804-1789
18 Viburnum Center Rd
Location 23/29Viburnum, MO 65566-7802 · Phone (573) 244-5406 · Fax (573) 244-5591
2300 Baugh Ln
Location 24/29Poplar Bluff, MO 63901-2402 · Phone (573) 785-3037 ext. 16044 · Fax (573) 413-4506
289 Broadway St
Location 25/29Neelyville, MO 63954-7176 · Phone (573) 804-9494 · Fax (573) 804-9493
1300 Victory Ln
Location 26/29Poplar Bluff, MO 63901-3300 · Phone (573) 785-5566 ext. 17097 · Fax (573) 413-4194
3001 Warrior Ln Ste A
Location 27/29Poplar Bluff, MO 63901-8685 · Phone (573) 785-7453 · Fax (573) 785-7429
11001 US-160
Location 28/29Harviell, MO 63945 · Phone (573) 804-9561 · Fax (573) 804-9581
109 Plum St Ste C
Location 29/29Doniphan, MO 63935-1225 · Phone (573) 351-0150
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