Individual provider Active NPI

Jefferson Aquino Bautista, NP-BC

  • Family Nurse Practitioner
  • Anaheim, CA
National Provider Identifier
1336218734
Registry record updated Dec 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
16338 Issued in CA
Practice address
1211 W la Palma Ave Ste 404
Anaheim, CA 92801-2806
Phone
(714) 772-8282
Fax
(714) 772-6493
NPI assigned
Nov 7, 2006
Last updated
Dec 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 16338 CA Primary

Addresses

Primary practice location

1211 W la Palma Ave Ste 404
Anaheim, CA 92801-2806

Mailing address

PO Box 15090
Anaheim, CA 92803-5090
Phone (714) 577-2121

Other identifiers 1

IdentifierTypeStateIssuer
486995OtherCARN

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210118000613 CA Practitioner - Nurse Practitioner 5092128892 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13522 Newport Ave
Suite 102
Tustin, CA 92780-3707
Phone (714) 573-8200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.07 of 100Reported as group
Quality
87.72
Promoting interoperability
96
Improvement activities
40
Cost
74.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
16338CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
The Huntington Medical Foundation CurrentSince Oct 1, 2024 Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Oct 21, 2024 Accepting new patients
Chest and Critical Care Consultants a Medical Group Family CurrentSince Dec 28, 2020 Accepting new patients
Chest and Critical Care Consultants CurrentSince Dec 28, 2020 Accepting new patients
GN Medical Associates, Inc. Family Past Accepting new patients
Hospice Touch, Inc. Past Accepting new patients

Locations

1211 W La Palma Ave
Ste 404
Anaheim, CA 92801
Phone (714) 772-1030

8635 W 3rd St
Ste 465W
Los Angeles, CA 90048
Phone (310) 423-0674

100 W California Blvd
Pasadena, CA 91105
Phone (626) 397-3445

65 N Madison Ave
Ste 800
Pasadena, CA 91101
Phone (626) 792-3141

999 N Tustin Ave
Ste 1
Santa Ana, CA 92705
Phone (714) 836-6800

4140 W 190th St
Torrance, CA 90504
Phone (310) 967-1780

13522 Newport Ave
Ste 102
Tustin, CA 92780
Phone (714) 573-8200

Organizations & group practices 6

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 4

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608768000000",
    "number": "1336218734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15090",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928035090",
            "telephone_number": "714-577-2121",
            "fax_number": "714-577-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE STE 404",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012806",
            "telephone_number": "714-772-8282",
            "fax_number": "714-772-6493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "JEFFERSON",
        "middle_name": "AQUINO",
        "credential": "NP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-12-24",
        "certification_date": "2020-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "16338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "486995",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.