Provider Demographics
NPI:1922292093
Name:RICAURTE, BASMA (MD)
Entity Type:Individual
Prefix:DR
First Name:BASMA
Middle Name:
Last Name:RICAURTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15805 PURITAS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-2611
Mailing Address - Country:US
Mailing Address - Phone:216-267-5139
Mailing Address - Fax:216-267-5133
Practice Address - Street 1:29099 HEALTH CAMPUS DR STE 130
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5255
Practice Address - Country:US
Practice Address - Phone:440-835-6163
Practice Address - Fax:440-871-9408
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089919207RC0200X, 207RS0012X
OH35.089919207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2954567Medicaid
OH04286471Medicare PIN