Tavisty Kay Baillio, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

T6728 Issued in TX

Practice address

4502 Medical Dr
San Antonio, TX 78229-4492

Phone

(210) 358-4000

NPI assigned

Apr 21, 2020

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

Other names 1

• Tavisty Kay Tarkenton Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

University of North Texas HSC, College of Osteopathic Med, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Medicine Resources, LLPGroup PAC ID 5890688212, 255 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Harris Methodist Hospital Southwest F Hospital, Fort Worth, TX, CCN 450779
• Texas Health Harris Methodist Hospital Cleburne Hospital, Cleburne, TX, CCN 450148

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Texas Medicine Resources, LLP

  • Emergency Medicine Physician
  • Fort Worth, TX
  • NPI 1376581900

  TX

  Medicare reassignment Care Compare group
• Complete Emergency Care Southlake LLC

  • Emergency Care Clinic/Center
  • Southlake, TX
  • NPI 1174937668
  NPD (past)
• La Vernia Erl Acquisition Partners LLC

  • Emergency Care Clinic/Center
  • La Vernia, TX
  • NPI 1225825946
  NPD (past)

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

• Texas Health Harris Methodist Hospital Cleburne

  • General Acute Care Hospital
  • Cleburne, TX
  • NPI 1396778064

  Hospital

  Care Compare affiliation
• Texas Health Harris Methodist Hospital Southwest Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1417980202

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1386264182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4308 DIAZ AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761076315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 MEDICAL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294492",
            "telephone_number": "210-358-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILLIO",
        "first_name": "TAVISTY",
        "middle_name": "KAY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-21",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "T6728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAVISTY",
            "last_name": "TARKENTON",
            "middle_name": "KAY",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samantha Ann Bailey
• Tennessee Bailey, M.D.
• Baileys San Antonio LLC
• Erika Elena Baillio, FNP-BC
• Michael Ray Baillio II, DO
• Vicki Baillon, MSN, RN, IBCLC
• Gregory Baima, PHD
• Charles Bain
• Kathryn Virginia Bain, MD
• Walter M Bain, MD

• All providers in San Antonio, TX
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; 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.