NPIMap

Individual provider Active NPI

Jessica Montalban Bautista, DO, MS

  • Family Medicine Physician
  • Parker, CO
National Provider Identifier
1629655006
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0069284 Issued in CO
Practice address
19641 E Parker Square Dr Ste a
Parker, CO 80134-7397
Phone
(303) 840-3800
Fax
(303) 840-8442
NPI assigned
Mar 24, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR.0069284 CO Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

19641 E Parker Square Dr Ste a
Parker, CO 80134-7397

Mailing address

19641 E Parker Square Dr Ste a
Parker, CO 80134-7397
Phone (303) 840-3800

Other practice location 1

1501 S Potomac St
Aurora, CO 80012-5411
Phone (303) 695-2600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20241106004173 CO Practitioner - Family Practice 7113451667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Portercare Adventist Health SystemGroup PAC ID 0941110886, 770 clinicians

Practice addresses (Care Compare)

19641 E Parker Square Dr a
Prac PC Aspen Creek
Parker, CO 80134-7397
Phone (303) 840-3800

2535 S Downing St
Denver, CO 80210-5850
Phone (303) 778-5797

Hospital & facility affiliations

  • AdventHealth Parker Hospital, Parker, CO, CCN 060114
  • Adventhealth Castle Rock Hospital, Castle Rock, CO, CCN 060125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Science

State licenses

LicenseStateTypeSpecialty
DR.0069284COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Portercare Adventist Health System CurrentSince Nov 18, 2024 Accepting new patients
Portercare Adventist Health System Current Accepting new patients
Portercare Adventist Health System Family Medicine CurrentSince Nov 18, 2024 Accepting new patients
Portercare Adventist Health System Past Accepting new patients

Locations

7750 S Broadway
Ste 260
Littleton, CO 80122
Phone (303) 734-8650

19641 E Parker Square Dr
Ste A
Parker, CO 80134
Phone (303) 406-0080

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

Interoperability endpoints

  • Direct secure messaging: jbautista3993316@adventhealth.direct-ci.com

Organizations & group practices 4

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.

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": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1629655006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19641 E PARKER SQUARE DR STE A",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801347397",
            "telephone_number": "303-840-3800",
            "fax_number": "303-840-8442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19641 E PARKER SQUARE DR STE A",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801347397",
            "telephone_number": "303-840-3800",
            "fax_number": "303-840-8442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 S Potomac St",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800125411",
            "country_code": "US",
            "telephone_number": "303-695-2600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "JESSICA",
        "middle_name": "MONTALBAN",
        "credential": "DO, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-24",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0069284",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Parker, CO

Sources for this page

Verify at the official NPI Registry.