NPIMap

Individual provider Active NPI

Jayson Lintag Bautista, APRN

  • Family Nurse Practitioner
  • Henderson, NV
National Provider Identifier
1023776309
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
847774 Issued in NV
Practice address
2831 Saint Rose Pkwy Ste 200
Henderson, NV 89052-4841
Phone
(702) 600-3721
Fax
(725) 266-7366
NPI assigned
Dec 3, 2021
Last updated
Dec 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 847774 NV Primary

Addresses

Primary practice location

2831 Saint Rose Pkwy Ste 200
Henderson, NV 89052-4841

Mailing address

138 Serpens Ave
Las Vegas, NV 89183-5030
Phone (714) 330-5486

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220411000267 NV Practitioner - Nurse Practitioner 4789070277 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dynamic Medical Group LLCGroup PAC ID 1153856158, 5 clinicians
Ares Advance Practice LLCGroup PAC ID 5395159107, 8 clinicians

Practice addresses (Care Compare)

3841 W Charleston Blvd
Suite 202
Las Vegas, NV 89102-1858
Phone (702) 780-6868

5660 W Flamingo Rd
Suite B
Las Vegas, NV 89103-2312
Phone (702) 596-2188

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.7 of 100Reported as group
Quality
100
Improvement activities
40
Cost
35.67

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
847774NVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Beautiful Mind of Las Vegas LLC CurrentSince Oct 19, 2024 Accepting new patients
Total Family Care Specialists CurrentSince May 1, 2025 Accepting new patients
Ares Advance Practice LLC CurrentSince Mar 1, 2022 Accepting new patients
Dynamic Medical Group LLC CurrentSince Oct 19, 2024 Accepting new patients

Locations

2843 Saint Rose Pkwy
Ste 110
Henderson, NV 89052
Phone (702) 233-4569

3280 N Rainbow Blvd
#110
Las Vegas, NV 89108
Phone (702) 233-4555

3841 W Charleston Blvd
Ste 202
Las Vegas, NV 89102
Phone (702) 623-7990

5660 W Flamingo Rd
Ste B
Las Vegas, NV 89103
Phone (702) 596-2188

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1023776309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 SERPENS AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891835030",
            "telephone_number": "714-330-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2831 SAINT ROSE PKWY STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524841",
            "telephone_number": "702-600-3721",
            "fax_number": "725-266-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "JAYSON",
        "middle_name": "LINTAG",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-03",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "847774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.