Jacqueline Ann Bautista, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

018206 Issued in IL

Practice address

200 N Berteau Ave
Elmhurst, IL 60126-2966

Phone

(630) 833-1400

Fax

(630) 941-4597

NPI assigned

May 17, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Jacqueline Ann Morales Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

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.

• Elmhurst Anesthesiologists, PC

  • Anesthesiology Physician
  • Elmhurst, IL
  • NPI 1376586610
  NPD (past)

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205043015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4423 N NEW ENGLAND AVE",
            "city": "HARWOOD HEIGHTS",
            "state": "IL",
            "postal_code": "607064825",
            "telephone_number": "312-543-3348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N BERTEAU AVE",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262966",
            "telephone_number": "630-833-1400",
            "fax_number": "630-941-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "JACQUELINE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "018206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "MORALES",
            "middle_name": "ANN",
            "prefix": "MISS",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Eugene J Bartucci, MD
• Kathryn Baubly
• Paul Michael Baubly, MD
• Christian Bautista, M.D
• Heather Bautista, LDN, N.D., CNS
• Be Well Chiropractic Clinics LLC
• Beams Technologies, Inc.
• Donald Christie Beard, DDS
• Emily Becker
• Mickayla Bedenian, LCSW

• Certified Registered Nurse Anesthetist in Elmhurst, IL
• Providers in Elmhurst, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.