Benjamin Genesis M Bautista II, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036130758 Issued in IL

Practice address

855 N Westhaven Dr
Oshkosh, WI 54904-7668

Phone

(920) 456-7400

NPI assigned

Aug 26, 2010

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 WI, IL2 enrollments

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 2

Specialty

Emergency Medicine

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Medicine Specialists SCGroup PAC ID 8729975461, 220 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension NE Wisconsin - St Elizabeth Campus Hospital, Appleton, WI, CCN 520009

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Emergency Medicine Specialists, S.C.

  • Emergency Medicine Physician
  • Milwaukee, WI
  • NPI 1568413524
  Medicare reassignment Care Compare group NPD
• Froedtert Manitowoc Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Manitowoc, WI
  • NPI 1437829975
  Medicare reassignment NPD
• Mea Chicago PC

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1891216354
  NPD

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

• Ascension NE Wisconsin, Inc

  • Ambulatory Surgical Clinic/Center
  • Menasha, WI
  • NPI 1124075536

  Hospital

  Care Compare affiliation
• Ascension NE Wisconsin, Inc

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1407803638
  Care Compare affiliation

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499644800000",
    "number": "1396051561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 S. MARSHALL BLVD., APT 805",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60623",
            "telephone_number": "920-750-3060",
            "fax_number": "773-521-0570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 N WESTHAVEN DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549047668",
            "telephone_number": "920-456-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "BENJAMIN GENESIS",
        "middle_name": "M",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-26",
        "last_updated": "2017-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "54794",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036130758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE LICENSE",
            "identifier": "036130758",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Paige Bassing, CSAC
• Kristian Noelle Bastress, DNP, APNP, FNP-BC
• Forrest T. Bates, MD
• Krista K Bauer
• Karl E Baum, MD
• Matthew S. Bay, P.A.
• Angela Marie Beach, NP-C
• Karly Becher, PHARMD/MBA
• Nicole Becher
• Jennifer L Beck, PHARMD

• Emergency Medicine Physician in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2017; 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.