Jialin Bao, M.D.
Individual provider Active NPI Anesthesiology Physician · Mishawaka, IN
NPI 1124159843 · NPPES record last updated Jan 28, 2010
Key facts
- NPI
- 1124159843
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 01061741A (IN)
- Practice address
- 5215 Holy Cross Parkway
Anesthesia Department
Mishawaka, IN 46545-1469 - Phone
- (574) 233-3123
- Fax
- (574) 233-3125
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint Joseph Regional Medical Center-South Bend Campus Inc
Cep America - Anesthesia PC
Practice addresses (Care Compare)
5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-5000
Hospital & facility affiliations
- Saint Joseph Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070530000439 | IN | Practitioner - Anesthesiology | 0648378539 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01061741A | IN | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America - Anesthesia PC | Anesthesiology | Current |
Accepting new patients |
| Cep America - Anesthesia PC | Anesthesiology | Current |
Accepting new patients |
| Saint Joseph Regional Medical Center-South Bend Campus, Inc. | Current |
Accepting new patients | |
| Saint Joseph Regional Medical Center-South Bend Campus, Inc | Anesthesiology | Current |
Accepting new patients |
| Saint Joseph Regional Medical Center-South Bend Campus, Inc | Current | Accepting new patients | |
| Surgery Center Anesthsia | Anesthesiology | Past | Accepting new patients |
Locations
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443
Interoperability endpoints
- jbao1147483@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 01061741A | IN | Yes |
Addresses
Primary practice location
5215 Holy Cross Parkway
Anesthesia Department
Mishawaka, IN 46545-1469
Mailing address
PO Box 1742
South Bend, IN 46634-1742
Phone (574) 233-3123
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200858550 | Medicaid | IN |
Other providers in Mishawaka, IN
- Eusebia Balderas
- Robert Balliet
- Carol Ann Banks
- Latisha Banks
- Olivia Larren Banks
- Jody M Barber
- Lachelle L Barnett
- Nikole Suzanne Barrett
- Barroso Therapy Services LLC
- Lacey Barroso
All providers in Mishawaka, IN · Anesthesiology Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.