Basic Information
| Provider Information | |||||||||
| NPI: | 1275577371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASS | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122739800 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| Address2: | 2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122738700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 05/31/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 33479 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | HP15843 | 01 | MN | HEALTHPARTNERS | OTHER | 055803600 | 05 | MN | MEDICAID | 1001013 | 01 | MN | PREFERRED ONE | OTHER | 15-60430 | 01 | MN | MEDICA CHOICE | OTHER | 31785900 | 05 | WI | MEDICAID | 36Q97BA | 01 | MN | BCBS PHALEN | OTHER | 768010 | 01 | MN | ARAZ | OTHER | 0055641 | 05 | MT | MEDICAID | 2538157 | 05 | IA | MEDICAID | 106109 | 01 | MN | UCARE | OTHER | 15-83243 | 01 | MN | MEDICA | OTHER | 25-70708 | 05 | MN | MEDICAID | 36Q99BA | 01 | MN | BCBS BETHESDA | OTHER |