Individual provider Active NPI

Kim Saiazar Bautista, LCSW

  • Social Worker
  • Lyons, NY
National Provider Identifier
1447375217
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
0732991 Issued in NY
Practice address
1519 Nye Road
Wayne Behavioral Health Network
Lyons, NY 14489
Phone
(315) 946-5722
Fax
(315) 946-7066
NPI assigned
Mar 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 0732991 NY Primary

Addresses

Primary practice location

1519 Nye Road
Wayne Behavioral Health Network
Lyons, NY 14489

Mailing address

7 Wallingford Rise
Fairport, NY 14450
Phone (315) 946-5722

Other names 1

  • Kim Saiazar Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091210000003 NY Practitioner - Clinical Social Worker 9436298114 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0732991NYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
County of Wayne CurrentSince Nov 1, 2009 Accepting new patients

Locations

1519 Nye Rd
Lyons, NY 14489
Phone (315) 946-5722

1519 Nye Rd
Ste 100
Lyons, NY 14489
Phone (315) 946-5722

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447375217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 WALLINGFORD RISE",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "14450",
            "telephone_number": "315-946-5722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 NYE ROAD",
            "address_2": "WAYNE BEHAVIORAL HEALTH NETWORK",
            "city": "LYONS",
            "state": "NY",
            "postal_code": "14489",
            "telephone_number": "315-946-5722",
            "fax_number": "315-946-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "KIM",
        "middle_name": "SAIAZAR",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "0732991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "SAIAZAR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lyons, NY

Sources for this page

Verify at the official NPI Registry.