Kristopher Kevin Caballero Baluyot

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

130 N Brand Blvd Ste 208
Glendale, CA 91203-2627

Phone

(818) 945-6003

NPI assigned

Oct 8, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shine MMG IncGroup PAC ID 6103257282, 25 clinicians

California Mobile Medical Group IncGroup PAC ID 7719330091, 16 clinicians

Aande Medical Group-a Professional Nursing CorporationGroup PAC ID 7719388230, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• A&E Medical Group-a Professional Nursing Corporation

  dba Cordial Healthcare Providers

  • Family Nurse Practitioner
  • Glendale, CA
  • NPI 1306424502
  Medicare reassignment Care Compare group
• California Mobile Medical Group Inc

  dba The Mobile DRS

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1588439061
  Medicare reassignment Care Compare group
• Shine MMG Inc

  dba Shine MMG

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1053930248
  Medicare reassignment Care Compare group
• Mobile Medical Group Inc

  dba TMD

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1487169660
  Medicare reassignment

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1215402185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 N BRAND BLVD STE 208",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 N BRAND BLVD STE 208",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032627",
            "telephone_number": "818-945-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALUYOT",
        "first_name": "KRISTOPHER",
        "middle_name": "KEVIN CABALLERO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-08",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2279P3900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Respiratory Therapist, Registered, Neonatal/Pediatrics",
            "state": "CA",
            "license": "26505",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lucine Baltayan
• Serina Baltayan
• Darwin Balthazar II
• Helen Baltian
• Svetlana Baltian
• Steffi Baluyot
• Erica Joy Banaag
• Nicole Kimberly Bancalari
• Bradford Manning Bancroft, MFT, RDT
• Eva Bandikian

• Medical Physician Assistant in Glendale, CA
• Providers in Glendale, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.