Bautista Medical Group Southern California, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A43293 Issued in CA

Legal business name

BAUTISTA MEDICAL GROUP SOUTHERN CALIFORNIA, INC.

Practice address

427 Central Ave
Fillmore, CA 93015

Phone

(805) 524-0777

Fax

(805) 524-0111

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jose Luis Bautista, MD

Title

Internist

Phone

(805) 524-2559

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Luis Guerrero Bautista, MD

  • Family Medicine Physician
  • Fresno, CA
  • NPI 1295712206
  Medicare reassignment NPD
• Jorge O Bautista, PA

  • Physician Assistant
  • Fillmore, CA
  • NPI 1336254705
  Medicare reassignment

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1629101340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 CENTRAL AVE",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "930151329",
            "telephone_number": "805-524-2559",
            "fax_number": "805-524-2596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 CENTRAL AVE",
            "city": "FILLMORE",
            "state": "CA",
            "postal_code": "93015",
            "telephone_number": "805-524-0777",
            "fax_number": "805-524-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "991 W 7th St",
            "address_purpose": "LOCATION",
            "city": "Oxnard",
            "state": "CA",
            "postal_code": "930306757",
            "country_code": "US",
            "telephone_number": "805-483-7500",
            "fax_number": "805-483-0500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAUTISTA MEDICAL GROUP SOUTHERN CALIFORNIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2023-01-31",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "INTERNIST",
        "authorized_official_telephone_number": "805-524-2559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A43293",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA15385",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A97270",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0063042",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nasr N Anees, MD
• Jovanny Arizmendi Barrueta
• Mariah Monique Barajas, REGISTERED COUNSELOR
• Donna Barlow
• Basso Pharmacy, Inc.
• Jorge O Bautista, PA
• Boma Corp
• Candice Marie Bowen, LVN
• Anita Nanda Brahme, DDS, MDS
• Amelia J Breckenridge, M.D.

• Family Medicine Physician in Fillmore, CA
• Providers in Fillmore, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.