NPIMap

Organization Active NPI

Teofilo S. Bautista, M.D., P.C

  • Primary Care Clinic/Center
  • Gary, IN
National Provider Identifier
1215110200
Registry record updated Dec 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
01032450A Issued in IN
Legal business name
TEOFILO S. BAUTISTA, M.D., P.C
Practice address
642 S Lake St
Gary, IN 46403-2967
Phone
(219) 938-4481
Fax
(219) 938-6480
NPI assigned
Dec 12, 2007
Last updated
Dec 12, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2007

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

Authorized official

Name
Dr. Teofilo Bautista, M.D.NPI 1801894076
Title
President
Phone
(219) 938-4481

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 01032450A IN Primary

Addresses

Primary practice location

642 S Lake St
Gary, IN 46403-2967

Mailing address

642 S Lake St
Gary, IN 46403-2967
Phone (219) 938-4481

National Provider Directory

National Provider Directory

Locations

642 S Lake St
Gary, IN 46403
Phone (219) 794-4024

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197417600000",
    "number": "1215110200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 S LAKE ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464032967",
            "telephone_number": "219-938-4481",
            "fax_number": "219-938-6480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 S LAKE ST",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464032967",
            "telephone_number": "219-938-4481",
            "fax_number": "219-938-6480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEOFILO S. BAUTISTA, M.D., P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2007-12-12",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "TEOFILO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-938-4481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IN",
            "license": "01032450A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.