Individual provider Active NPI

Michaela Charlotte Bailly, PA-C

  • Medical Physician Assistant
  • Los Alamos, NM
National Provider Identifier
1205565504
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA2022-0098 Issued in NM
Practice address
3917 West Rd Ste a
Los Alamos, NM 87544-2292
Phone
(505) 661-8900
Fax
(505) 661-8916
NPI assigned
Jun 10, 2022
Last updated
Feb 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2022-0098 NM Primary

Addresses

Primary practice location

3917 West Rd Ste a
Los Alamos, NM 87544-2292

Mailing address

3917 West Rd Ste a
Los Alamos, NM 87544-2292
Phone (505) 661-8900

Other identifiers 1

IdentifierTypeStateIssuer
PA2022-0098OtherNMNEW MEXICO MEDICAL BOARD LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221110002721 NM Practitioner - Physician Assistant 1355718925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Associates of Northern New MexicoGroup PAC ID 1557354339, 14 clinicians

Practice addresses (Care Compare)

3917 W Rd
Suite a
Los Alamos, NM 87544-2292
Phone (505) 661-8900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.11 of 100Reported as group
Quality
98.94
Promoting interoperability
81
Improvement activities
40
Cost
80.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 1

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

Hospital & facility affiliations 2

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": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1205565504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3917 WEST RD STE A",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875442292",
            "telephone_number": "505-661-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3917 WEST RD STE A",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875442292",
            "telephone_number": "505-661-8900",
            "fax_number": "505-661-8916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILLY",
        "first_name": "MICHAELA",
        "middle_name": "CHARLOTTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-10",
        "last_updated": "2024-02-19",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2022-0098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW MEXICO MEDICAL BOARD LICENSE",
            "identifier": "PA2022-0098",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Alamos, NM

Sources for this page

Verify at the official NPI Registry.