NPIMap

Individual provider Active NPI

Vladimir Bautista, CRNA

  • Certified Registered Nurse Anesthetist
  • Pinehurst, NC
National Provider Identifier
1427469816
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
133834 Issued in NC
Practice address
155 Memorial Dr
Pinehurst, NC 28374-8710
Phone
(910) 715-1010
Fax
(910) 715-1026
NPI assigned
May 19, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041374765 IL
Certified Registered Nurse Anesthetist 367500000X 133834 NC Primary

Addresses

Primary practice location

155 Memorial Dr
Pinehurst, NC 28374-8710

Mailing address

155 Memorial Dr
Pinehurst, NC 28374-8710
Phone (331) 221-1000

Other practice location 1

155 E Brush Hill Rd
Elmhurst, IL 60126-5658
Phone (331) 221-0097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170929002557 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5496976409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Firsthealth of the Carolinas IncGroup PAC ID 8820909377, 138 clinicians

Practice addresses (Care Compare)

155 Memorial Dr
Pinehurst, NC 28374-8710
Phone (910) 215-1000

Hospital & facility affiliations

  • Firsthealth Moore Regional Hospital Hospital, Pinehurst, NC, CCN 340115

Merit-based Incentive Payment System (MIPS)

Final score
86.75 of 100Reported as group
Quality
77.19
Promoting interoperability
86
Improvement activities
40
Cost
80.74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
041374765ILMDRegistered Nurse
133834NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Firsthealth of the Carolinas, Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 28, 2017 Accepting new patients
Firsthealth of the Carolinas, Inc Dba Firsthealth Weight Management Clinic CurrentSince Aug 28, 2017 Accepting new patients
Firsthealth of the Carolinas, Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
RLT Neurologic Associates, LTD. Past Accepting new patients

Locations

155 Memorial Dr
Pinehurst, NC 28374
Phone (910) 215-1000

Organizations & group practices 15

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.

View all 15

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": "1400457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1427469816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 MEMORIAL DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748710",
            "telephone_number": "331-221-1000",
            "fax_number": "630-472-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 MEMORIAL DR",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748710",
            "telephone_number": "910-715-1010",
            "fax_number": "910-715-1026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 E Brush Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "IL",
            "postal_code": "601265658",
            "country_code": "US",
            "telephone_number": "331-221-0097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "VLADIMIR",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041374765",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "133834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.