Jose Gomez Bautista, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD61127903 Issued in WA

Practice address

624 E Front Ave
Spokane, WA 99202-2139

Phone

(509) 626-9900

Fax

(509) 626-9917

NPI assigned

Apr 30, 2018

Last updated

Oct 19, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Internal Medicine

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services - WashingtonGroup PAC ID 2860552973, 266 clinicians

Washington Pac Services PCGroup PAC ID 4082986070, 43 clinicians

Wa Pacs 2 PCGroup PAC ID 6901156538, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Mary Medical Center Hospital, Walla Walla, WA, CCN 500002
• Washington State Walla Walla Veterans Home Nursing home, Walla Walla, WA, CCN 505530

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jgomezbautista924474@wm.providencedirect.org

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Washington State Walla Walla Veterans Home

  • Skilled Nursing Facility
  • Walla Walla, WA
  • NPI 1548627011

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

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.

• Providence Health & Services - Washington

  dba Providence Medical Group Southeast Washington

  • Family Medicine Physician
  • Walla Walla, WA
  • NPI 1922259738

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Wa Pacs 2 PC

  • Hospitalist Physician
  • Tacoma, WA
  • NPI 1144706532
  Medicare reassignment Care Compare group NPD
• Washington Pac Services PC

  • Hospitalist Physician
  • Spokane, WA
  • NPI 1336678168
  Medicare reassignment Care Compare group NPD
• CS Pacs 3 Northwest, LLC

  • Hospitalist Physician
  • Puyallup, WA
  • NPI 1811752066
  Medicare reassignment NPD
• Providence Health & Services Washington

  dba Providence Medical Group

  • Pulmonary Disease Physician
  • Spokane, WA
  • NPI 1194099390

  Internal Medicine

  Medicare reassignment NPD
• Providence Health & Services - Washington

  dba Providence Medical Group Southeast Washington Imaging

  • Diagnostic Radiology Physician
  • Walla Walla, WA
  • NPI 1306097126
  NPD
• Providence Health & Services Washington

  dba PMG PHC Providence Express Care

  • General Practice Physician
  • Spokane, WA
  • NPI 1306391446
  NPD
• Providence Health & Services - Washington

  dba Providence St Mary Medical Center

  • General Acute Care Hospital
  • Walla Walla, WA
  • NPI 1386895886
  NPD (past)
• Washington State Walla Walla Veterans Home

  • Skilled Nursing Facility
  • Walla Walla, WA
  • NPI 1548627011
  NPD (past)

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

• Providence Health & Services - Washington

  dba Providence St Mary Medical Center

  • General Acute Care Hospital
  • Walla Walla, WA
  • NPI 1386895886
  Care Compare affiliation
• Washington State Walla Walla Veterans Home

  • Skilled Nursing Facility
  • Walla Walla, WA
  • NPI 1548627011

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1508354010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1829 W 25TH CT",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993373613",
            "telephone_number": "509-579-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 E FRONT AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022139",
            "telephone_number": "509-626-9900",
            "fax_number": "509-626-9917"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 W 8th Ave # 9N",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992042307",
            "country_code": "US",
            "telephone_number": "509-710-7855",
            "fax_number": "509-474-3245",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 W Poplar St",
            "address_purpose": "LOCATION",
            "city": "Walla Walla",
            "state": "WA",
            "postal_code": "993622846",
            "country_code": "US",
            "telephone_number": "509-897-2980",
            "fax_number": "509-897-5184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ BAUTISTA",
        "first_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-30",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61127903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgomezbautista924474@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "401 W Poplar St",
            "city": "Walla Walla",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993622846",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgomezbautista924474@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "624 E Front Ave",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992022139",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgomezbautista924474@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "101 W 8th Ave # 9N",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992042307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Grant Golliehon
• Tatyana Golub, DPT
• Ruth Golubenko
• Iuliia Golubova
• Michelle Gomba
• Kimberly Estefania Gomez-Piragauta, BASW
• Allison Lorraine Gomez
• Crystal Gomez
• Elizabeth Ashley Gomez
• Katie L Gomez, ARNP

• Internal Medicine Physician in Spokane, WA
• Providers in Spokane, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.