Individual provider Active NPI

Alvin Bautista, D.C., M.S.

  • Chiropractor
  • Tigard, OR
National Provider Identifier
1679966824
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5626 Issued in OR
Practice address
7405 SW Beveland Rd
Tigard, OR 97223-8610
Phone
(503) 746-6095
NPI assigned
Mar 12, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5626 OR Primary

Addresses

Primary practice location

7405 SW Beveland Rd
Tigard, OR 97223-8610

Mailing address

7405 SW Beveland Rd
Tigard, OR 97223-8610
Phone (503) 746-6095

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250304003000 OR Practitioner - Chiropractic 4688987522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Western States College of Chiropractic, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7405 SW Beveland Rd
Tigard, OR 97223-8610
Phone (503) 746-6095

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5626ORMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Chiropractic Wellness Chiropractor CurrentSince Dec 22, 2024 Accepting new patients

Locations

17020 SW Upper Boones Ferry Rd
Ste 300
Portland, OR 97224
Phone (503) 462-5445

7405 SW Beveland Rd
Tigard, OR 97223
Phone (503) 746-6095

Organizations & group practices 1

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": "1426118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1679966824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7405 SW BEVELAND RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238610",
            "telephone_number": "503-746-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7405 SW BEVELAND RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238610",
            "telephone_number": "503-746-6095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "ALVIN",
        "credential": "D.C., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-12",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OR",
            "license": "5626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.