Active NPI
Maryrose Bautista, M.D.
- Internal Medicine Physician
- French Camp, CA
National Provider Identifier
1114945128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- A70192
- Practice address
- 7777 South Freedom Road
French Camp, CA 95231 - Phone
- (209) 946-3400
- NPI assigned
- Jul 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A70192 | CA | Primary |
Addresses
Primary practice location
7777 South Freedom Road
French Camp, CA 95231
Mailing address
7777 South Freedom Road
French Camp, CA 95231
Phone (209) 946-3400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121112000597 | CA | Order and Referring Only - Internal Medicine | 8820249212 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114945128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7777 SOUTH FREEDOM ROAD",
"city": "FRENCH CAMP",
"state": "CA",
"postal_code": "95231",
"telephone_number": "209-946-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7777 SOUTH FREEDOM ROAD",
"city": "FRENCH CAMP",
"state": "CA",
"postal_code": "95231",
"telephone_number": "209-946-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA",
"first_name": "MARYROSE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "A70192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in French Camp, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.