DR. DERWOOD E BASHAM (D.O.) – Family Medicine Physician, NPI 1053535120

DR. DERWOOD E BASHAM (D.O.) is a healthcare provider. based in Roseburg, Oregon. specializing in FAMILY PRACTICE. They hold the professional credentials D.O.. They hold a License No. DO171270 (OR). The NPI Number for DR. DERWOOD E BASHAM (D.O.) is 1053535120

Main info

Male
22 Years Of Experience
Accepts Medicare Assignment
Name
DR. DERWOOD E BASHAM (D.O.)
NPI
1053535120
Phone
(541) 672-8533
Address
2371 NE STEPHENS ST
Enumeration Date
12 April 2007
Last Update Date
17 July 2015

Doctor Profile

Medical School Name
UNIVERSITY OF PIKEVILLE, KENTUCKY COLLEGE OF OSTEOPATHIC MED
Secondary Phone
5414963504
Graduation Year
2004 (22 years ago)
PAC ID
6800996141
Group Practice PAC ID
0345233078
Professional Enrollment ID
I20150501000275
Address ID
OR974439620GL20170HWYX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

2,081 FAMILY PRACTICE in OR

Provider Addresses for DR. DERWOOD E BASHAM (D.O.)

  • 2371 NE STEPHENS ST

    SUITE 200

    ROSEBURG, OR 974701372

    Phone: (541) 672-8533

    Fax: (541) 672-4993

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-01-24

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220124002324IFamily PracticeORTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
96127Assessment of emotional or behavioral problems7139$0
83036Hemoglobin a1c level2626$0
81002Urinalysis, manual test1414$0
View full utilization report →

Insurance plans in this area (ZIP 97470)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0345233078View full group profile
NameSpecialtyState
Family PracticeOR
-OR
-OR
Registered Dietitian Or Nutrition ProfessionalOR
Nurse PractitionerOR
-OR
Family PracticeOR
Family PracticeOR
Pediatric MedicineOR
Physician AssistantOR

Reviews

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Frequently asked questions

What is the 10-digit NPI for DR. DERWOOD E BASHAM (D.O.)?
DR. DERWOOD E BASHAM (D.O.) — NPI 1053535120 — is the standard way to identify this listing.
Is DR. DERWOOD E BASHAM (D.O.) listed as active for patients and plans?
The listing shows DR. DERWOOD E BASHAM (D.O.) as active in the NPI system.
What taxonomy line describes DR. DERWOOD E BASHAM (D.O.)?
For research purposes, treat DR. DERWOOD E BASHAM (D.O.) as Family Medicine Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for DR. DERWOOD E BASHAM (D.O.)?
DR. DERWOOD E BASHAM (D.O.)'s geographic hint is Roseburg, Oregon in our summary view.
Why does DR. DERWOOD E BASHAM (D.O.) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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