Individual ProviderLara BashouraInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address1515 Holcombe Blvd, Houston, TX 77030-4000(713) 792-6161(713) 792-2991PECOS EnrollmentBased on the most recent information from CMS, provider Lara Bashoura is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 8:41 AM.Profile DetailsProvider ID1841399920Provider TypeIndividualFull NameBashoura, LaraCredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date9/22/2006Last Updated7/1/2021Contact InformationPractice LocationPractice Address1515 Holcombe Blvd, Houston, TX 77030-4000Phone(713) 792-6161FaxUnlisted FaxMailing LocationMailing AddressPO Box 4439, Houston, TX 77210-4439Phone(713) 792-2991FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207RP1001XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseM0349TexasProvider IdentifiersIDDescriptionIssuerID8P2675DescriptionOtherIssuerBCBSTexasIDP00205009DescriptionOtherIssuerRR MEDICARETexasID172796801DescriptionMedicaidIssuerUnlistedTexasID172796802DescriptionOtherIssuerMEDICAID - CSHCNTexas