NPIMap

Individual provider Active NPI

Dan F Bautista, M.D.

  • Family Medicine Physician
  • Fairborn, OH
National Provider Identifier
1629006903
Registry record updated Sep 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35073682B Issued in OH
Practice address
1840 Commerce Center Blvd
Fairborn, OH 45324-6337
Phone
(937) 754-4580
Fax
(937) 754-4575
NPI assigned
Jun 28, 2006
Last updated
Sep 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35073682B OH Primary

Addresses

Primary practice location

1840 Commerce Center Blvd
Fairborn, OH 45324-6337

Mailing address

1840 Commerce Center Blvd
Fairborn, OH 45324-6337
Phone (937) 754-4580

Other identifiers 12

IdentifierTypeStateIssuer
000000259761OtherOHBLUE CROSS BLUE SHIELD
320049293027OtherOHCARESOURCE
300107OtherOHAMERIGROUP PIN
P12036623OtherOHMULTIPLAN
2871969MedicaidOH
2897281OtherOHCIGNA
2080233MedicaidOH
32004929300OtherOHBWC PIN
D7368201OtherOHHUMANA
5405631OtherOHAETNA
0109918OtherOHUNITED HEALTHCARE
310809436DABOtherOHSUMMIT PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100528000000 OH Practitioner - Family Practice 1052345808 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1840 Commerce Ctr Blvd
Fairborn, OH 45324-6337
Phone (937) 754-4580

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.63 of 100Reported as individual
Quality
100
Improvement activities
40
Cost
82.11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dan F Bautista MD LLC Family Medicine CurrentSince Mar 10, 2003 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

1840 Commerce Center Blvd
Fairborn, OH 45324
Phone (937) 754-4580

Organizations & group practices 2

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 7

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316390400000",
    "number": "1629006903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 COMMERCE CENTER BLVD",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246337",
            "telephone_number": "937-754-4580",
            "fax_number": "937-754-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 COMMERCE CENTER BLVD",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453246337",
            "telephone_number": "937-754-4580",
            "fax_number": "937-754-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "DAN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2011-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35073682B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000259761",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "320049293027",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP PIN",
            "identifier": "300107",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "P12036623",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2871969",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2897281",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2080233",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC PIN",
            "identifier": "32004929300",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "D7368201",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5405631",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0109918",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMIT PIN",
            "identifier": "310809436DAB",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairborn, OH

Sources for this page

Verify at the official NPI Registry.