Jacqueline J. Bae, MD

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

Practice address

925 Bevins CT
Lakeport, CA 95453-9754

Phone

(707) 263-8382

Fax

(707) 263-0329

NPI assigned

May 2, 2011

Last updated

May 2, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Ft. McDermitt Paiute-Shoshone Tribe

  dba Ft. McDermitt Wellness Center

  • Federally Qualified Health Center (FQHC)
  • McDermitt, NV
  • NPI 1316449291
  NPD

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

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304294400000",
    "number": "1245521749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1558",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954531558",
            "telephone_number": "213-663-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 BEVINS CT",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954539754",
            "telephone_number": "707-263-8382",
            "fax_number": "707-263-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAE",
        "first_name": "JACQUELINE",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-02",
        "last_updated": "2011-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisa Arroyo
• Javier Arroyo, D.C.
• Fareed Ramzi Asfour, M.D.
• Gemalli Austin, RD, CDE
• Angelica Ayala
• Kristina Ballard, OTR/L
• Jillian R Barna, MFTI
• Cynthia Barnes
• Charissa M Barsos, NP
• Harneet Singh Bath, M.D.

• Nutrition Education Nutritionist in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Nutrition Education Nutritionist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; 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.