Individual provider Active NPI

Betalina Blanco Bumatay, M.D.

  • Pediatrics Physician
  • Manteca, CA
National Provider Identifier
1477510097
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A50060 Issued in CA
Practice address
165 Saint Dominics Dr Ste 201
Manteca, CA 95337-7802
Phone
(209) 823-2345
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A50060 CA Primary

Addresses

Primary practice location

165 Saint Dominics Dr Ste 201
Manteca, CA 95337-7802

Mailing address

PO Box 255228
Sacramento, CA 95865-5228

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20201008002304 CA Practitioner - Pediatric Medicine 7012279045 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A50060CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
First Choice Physician Partners Pediatrics CurrentSince Jun 20, 2020 Accepting new patients
First Choice Physician Partners CurrentSince Jun 20, 2020 Accepting new patients
First Choice Physician Partners Current Accepting new patients
Sutter Valley Medical Foundation Pediatrics Current Accepting new patients
Sutter Valley Medical Foundation CurrentSince Jan 21, 2024 Accepting new patients
Sutter Valley Medical Foundation Pediatrics CurrentSince Jan 21, 2024 Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

2720 Low Ct
Fairfield, CA 94534
Phone (707) 428-2731

815 Court St
Ste 7
Jackson, CA 95642
Phone (209) 257-5900

1300 W Lodi Ave
Ste P
Lodi, CA 95242
Phone (209) 366-1990

1262 E North St
Manteca, CA 95336
Phone (209) 823-7646

1026 Lifestyle St
Manteca, CA 95337
Phone (209) 823-2345

165 Saint Dominics Dr
Ste 201
Manteca, CA 95337
Phone (209) 239-0120

1234 E North St
Ste 103
Manteca, CA 95336
Phone (209) 647-3101

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

2800 L St
Ste 500
Sacramento, CA 95816
Phone (916) 454-6850

Interoperability endpoints

  • Direct secure messaging: bblancobumatay264637@hisp.ehr.sutterhealth.org
  • Direct secure messaging: betalina.bumatay@843.chartlogic.direct-ci.com

Organizations & group practices 7

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1477510097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255228",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958655228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 SAINT DOMINICS DR STE 201",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953377802",
            "telephone_number": "209-823-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUMATAY",
        "first_name": "BETALINA",
        "middle_name": "BLANCO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A50060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manteca, CA

Sources for this page

Verify at the official NPI Registry.