Individual provider Active NPI

Jake Hamilton Bayless, DO

  • Hospitalist Physician
  • Charlotte, NC
National Provider Identifier
1124558135
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2023-03317 Issued in NC
Practice address
10905 Providence Rd W
Ste G200
Charlotte, NC 28277-1538
Phone
(980) 488-4900
Fax
(980) 488-4905
NPI assigned
Jun 13, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X LL40693 SC
Hospitalist Physician 208M00000X 2023-03317 NC Primary

Addresses

Primary practice location

10905 Providence Rd W
Ste G200
Charlotte, NC 28277-1538

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (980) 488-4900

Other practice location 1

853 N Church St Ste 510
Spartanburg, SC 29303-3077
Phone (864) 560-6193

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240326002392 NC Practitioner - Family Practice 5890069306 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

3333 Silas Creek Pkwy
Winston Salem, NC 27103-3013
Phone (336) 718-7597

Hospital & facility affiliations

  • Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195
  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL40693SCMDFamily Medicine Physician
2023-03317NCMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Mar 1, 2024 Accepting new patients
Novant Health Medical Group, LLC Hospitalist CurrentSince Mar 1, 2024 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Ballantyne Medical Center LLC Past Accepting new patients

Locations

10905 Providence Rd W
Ste G200
Charlotte, NC 28277
Phone (980) 488-4900

1901 Randolph Rd
Charlotte, NC 28207
Phone (704) 316-2000

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: jbayless1327413@direct.novanthealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1497312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1124558135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "980-488-4900",
            "fax_number": "980-488-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10905 PROVIDENCE RD W",
            "address_2": "STE G200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282771538",
            "telephone_number": "980-488-4900",
            "fax_number": "980-488-4905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "853 N Church St Ste 510",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293033077",
            "country_code": "US",
            "telephone_number": "864-560-6193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAYLESS",
        "first_name": "JAKE",
        "middle_name": "HAMILTON",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-13",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL40693",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2023-03317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.