Active NPI
Jon Todd Baughman, PAC
- Physician Assistant
- Sutton, AK
National Provider Identifier
1275629339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA20020040
- Practice address
- 11495 Callison Street
Life House Community Health Center
Sutton, AK 99674-0000 - Phone
- (907) 631-7665
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA20020040 | NM | Primary |
Addresses
Primary practice location
11495 Callison Street
Life House Community Health Center
Sutton, AK 99674-0000
Mailing address
PO Box 4363
870 Heron Drive
Page, AZ 86040-4363
Phone (928) 660-1337
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 442226 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA20020040 | NM | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS PHS Naihs Kayenta Health Center | Past | Accepting new patients | |
| Southcentral Foundation | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Kayenta Health Center
- General Acute Care Hospital
- Kayenta, AZ
- NPI 1720387418
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456963200000",
"number": "1275629339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4363",
"address_2": "870 HERON DRIVE",
"city": "PAGE",
"state": "AZ",
"postal_code": "860404363",
"telephone_number": "928-660-1337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11495 CALLISON STREET",
"address_2": "LIFE HOUSE COMMUNITY HEALTH CENTER",
"city": "SUTTON",
"state": "AK",
"postal_code": "996740000",
"telephone_number": "907-631-7665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUGHMAN",
"first_name": "JON",
"middle_name": "TODD",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2016-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NM",
"license": "PA20020040",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "442226",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sutton, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.