Jorge O Bautista, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA15385 Issued in CA

Practice address

427 Central Ave
Fillmore, CA 93015-1329

Phone

(805) 524-2559

Fax

(805) 524-2596

NPI assigned

Aug 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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, 1998

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• A-1 Home Health Services Inc Home health agency, Simi Valley, CA, CCN 058118

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jorge.bautista.p1@direct.omnifamilyhealth.nextgenshare.com
• Direct secure messaging: bautistajorge.223.5921@securemailmdscloud.mdsynergy.com

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.

• Bautista Medical Group Southern California, Inc.

  • Family Medicine Physician
  • Fillmore, CA
  • NPI 1629101340

  CA

  Medicare reassignment
• Sespe Medical, Inc.

  • Rural Health Clinic/Center
  • Fillmore, CA
  • NPI 1336385244
  NPD
• Fresno Community Hospital and Medical Center

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1104906569
  NPD (past)
• Omni Family Health

  • Federally Qualified Health Center (FQHC)
  • Delano, CA
  • NPI 1417962457
  NPD (past)
• Saint Agnes Medical Center

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1205845567
  NPD (past)
• Valley Children'S Hospital

  • Children's Hospital
  • Madera, CA
  • NPI 1952312043
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• A-1 Home Health Services, Inc.

  • Home Health Agency
  • Simi Valley, CA
  • NPI 1467631887
  Care Compare affiliation

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709251200000",
    "number": "1336254705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 CENTRAL AVE",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "930151329",
            "telephone_number": "805-524-2559",
            "fax_number": "805-524-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 CENTRAL AVE",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "930151329",
            "telephone_number": "805-524-2559",
            "fax_number": "805-524-2596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "991 W 7th St",
            "address_purpose": "LOCATION",
            "city": "Oxnard",
            "state": "CA",
            "postal_code": "930306757",
            "country_code": "US",
            "telephone_number": "805-483-7500",
            "fax_number": "805-485-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "JORGE",
        "middle_name": "O",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA15385",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0063042",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jovanny Arizmendi Barrueta
• Mariah Monique Barajas, REGISTERED COUNSELOR
• Donna Barlow
• Basso Pharmacy, Inc.
• Bautista Medical Group Southern California, Inc.
• Boma Corp
• Candice Marie Bowen, LVN
• Anita Nanda Brahme, DDS, MDS
• Amelia J Breckenridge, M.D.
• Kelly Lynn Brooks, PA-C

• All providers in Fillmore, CA
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.