NPIMap

Individual provider Active NPI

Mario Bautista Sy, M.D.

  • Hematology & Oncology Physician
  • Bettendorf, IA
National Provider Identifier
1447210638
Registry record updated Dec 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
34978 Issued in IA
Practice address
1351 Kimberly Rd
Ste 100
Bettendorf, IA 52722-4193
Phone
(563) 355-7733
Fax
(563) 355-9077
NPI assigned
Mar 23, 2006
Last updated
Dec 14, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 34978 IA
Hematology & Oncology Physician 207RH0003X 34978 IA Primary

Addresses

Primary practice location

1351 Kimberly Rd
Ste 100
Bettendorf, IA 52722-4193

Mailing address

1351 Kimberly Rd
Ste 100
Bettendorf, IA 52722-4193
Phone (563) 355-7733

Other identifiers 3

IdentifierTypeStateIssuer
2110700MedicaidIA
34565OtherWELLMARK BC BS
421423259OtherFEDERAL TAX INDENTIFICATI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060315000467 IA Practitioner - Hematology/OncologyPractitioner - Internal Medicine 2860409893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
State University of IowaGroup PAC ID 7618884230, 1,886 clinicians

Practice addresses (Care Compare)

1351 Kimberly Rd
Suite 100
Bettendorf, IA 52722-4193
Phone (563) 355-7733

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.02 of 100Reported as group
Quality
75.68
Promoting interoperability
78
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34978IAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
State University of Iowa CurrentSince Feb 24, 2017 Accepting new patients

Locations

1351 Kimberly Rd
Ste 100
Bettendorf, IA 52722
Phone (563) 355-7733

200 Hawkins Dr
Iowa City, IA 52242
Phone (319) 356-2633

200 Hawkins Dr
#H
Iowa City, IA 52242

Interoperability endpoints

  • Direct secure messaging: msy103000@uihcdirect.org

Organizations & group practices 1

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 5

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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355443200000",
    "number": "1447210638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 KIMBERLY RD",
            "address_2": "STE 100",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224193",
            "telephone_number": "563-355-7733",
            "fax_number": "563-355-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 KIMBERLY RD",
            "address_2": "STE 100",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224193",
            "telephone_number": "563-355-7733",
            "fax_number": "563-355-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SY",
        "first_name": "MARIO",
        "middle_name": "BAUTISTA",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2012-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "34978",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IA",
            "license": "34978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2110700",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC BS",
            "identifier": "34565",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX INDENTIFICATI",
            "identifier": "421423259",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bettendorf, IA

Sources for this page

Verify at the official NPI Registry.