NPIMap

Individual provider Active NPI

Juan Guillermo Bastidas, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Ashland, KY
National Provider Identifier
1033301080
Registry record updated Jul 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
49423 Issued in KY
Practice address
613 23Rd St Ste 210
Ashland, KY 41101-2868
Phone
(606) 326-9847
Fax
(606) 324-3418
NPI assigned
Aug 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD.201742 LA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X A115149 CA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 49423 KY Primary

Addresses

Primary practice location

613 23Rd St Ste 210
Ashland, KY 41101-2868

Mailing address

PO Box 2379
Ashland, KY 41105-2379
Phone (606) 408-6200

Other identifiers 2

IdentifierTypeStateIssuer
0193538MedicaidOH
7100454120MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, WV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180110002314 OH Practitioner - Thoracic SurgeryPractitioner - General SurgeryPractitioner - Cardiac Surgery 7315008950 Reassigns benefits to 1 organization
I20230828002526 WV Practitioner - Thoracic Surgery 7315008950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Mary'S Medical Management, LLCGroup PAC ID 5890897151, 92 clinicians

Practice addresses (Care Compare)

2828 1St Ave
Suite 200
Huntington, WV 25702-1236
Phone (304) 399-7530

Hospital & facility affiliations

  • St Marys Medical Center Hospital, Huntington, WV, CCN 510007
  • Cabell Huntington Hospital, Inc Hospital, Huntington, WV, CCN 510055
  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
115149CAMDClinical Social Worker
MD.201742LAMDSurgery Physician
A115149CAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Medical Management, LLC CurrentSince Sep 1, 2023 Accepting new patients
St. Mary'S Medical Management, LLC Surgery CurrentSince Sep 1, 2023 Accepting new patients
Kings Daughters Medical Specialties Inc CurrentSince Jan 1, 2018 Accepting new patients
Kings Daughters Medical Specialties Inc Current Accepting new patients
St. Mary'S Medical Center Inc Past Accepting new patients

Locations

2201 Lexington Ave
Ashland, KY 41101
Phone (606) 268-2560

1242 Crescent Dr
Wheelersburg, OH 45694
Phone (740) 574-8441

3075 US Route 60
Huntington, WV 25705
Phone (304) 733-0004

2900 1st Ave
Huntington, WV 25702
Phone (304) 526-1111

2828 1st Ave
Ste 200
Huntington, WV 25702
Phone (304) 399-7530

Interoperability endpoints

  • Direct secure messaging: jbastidas59786@direct.kdhealth.us
  • FHIR API: https://fhir-myrecord.cerner.com/r4/704af85e-ff7f-4141-a47d-5f79ab640202/

Organizations & group practices 5

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

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500595200000",
    "number": "1033301080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2379",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411052379",
            "telephone_number": "606-408-6200",
            "fax_number": "606-408-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 23RD ST STE 210",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411012868",
            "telephone_number": "606-326-9847",
            "fax_number": "606-324-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIDAS",
        "first_name": "JUAN",
        "middle_name": "GUILLERMO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-14",
        "last_updated": "2017-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "MD.201742",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A115149",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "KY",
            "license": "49423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0193538",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100454120",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, KY

Sources for this page

Verify at the official NPI Registry.