Individual provider Active NPI

Ivan Baylosis

  • Certified Registered Nurse Anesthetist
  • Colton, CA
National Provider Identifier
1699299073
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
95000862 Issued in CA
Practice address
400 N Pepper Ave
Colton, CA 92324-1801
Phone
(909) 580-1000
NPI assigned
Jul 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 95000862 CA Primary

Addresses

Primary practice location

400 N Pepper Ave
Colton, CA 92324-1801

Mailing address

580 Anton Blvd Unit 330
Costa Mesa, CA 92626-1998
Phone (310) 691-6129

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180320003146 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0749542298 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Om P. Chaurasia, MD, Inc.Group PAC ID 8123216884, 7 clinicians
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

26421 Crown Valley Pkwy
Suite 140a
Mission Viejo, CA 92691-8565
Phone (949) 365-8836

3430 E la Palma Ave
Anaheim, CA 92806-2020
Phone (888) 988-2800

3460 E la Palma Ave
Anaheim, CA 92806-2020
Phone (714) 644-2010

5475 E la Palma Ave
Anaheim, CA 92807-2075
Phone (714) 279-6088

6640 Alton Pkwy
Irvine, CA 92618-3734
Phone (949) 932-5000

6650 Alton Pkwy
Irvine, CA 92618-3734
Phone (949) 932-5000

6670 Alton Pkwy
Irvine, CA 92618-3734
Phone (949) 932-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Oct 1, 2019 Accepting new patients
Liberty Anesthesia Consultants LLC CurrentSince Mar 1, 2023 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Om P. Chaurasia, MD, Inc. CurrentSince May 16, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 1, 2019 Accepting new patients
Orange County Digestive Anesthesia, Inc. CurrentSince Sep 7, 2023 Accepting new patients
Marquee Anesthesia Consultants Inc Nurse Anesthetist, Certified Registered CurrentSince Jun 11, 2019 Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

441 N Lakeview Ave
Anaheim, CA 92807
Phone (714) 279-4000

700 W El Norte Pkwy
Escondido, CA 92026
Phone (760) 738-7830

1400 Reynolds Ave
Ste 125
Irvine, CA 92614
Phone (657) 900-4536

5 Holland
Ste 101
Irvine, CA 92618
Phone (949) 588-2199

29300 Portola Pkwy
Ste A
Lake Forest, CA 92630
Phone (949) 305-3913

26421 Crown Valley Pkwy
Ste 140B
Mission Viejo, CA 92691
Phone (949) 356-8836

26421 Crown Valley Pkwy
Ste 140A
Mission Viejo, CA 92691
Phone (949) 365-8836

73950 Alessandro Dr
Ste 1
Palm Desert, CA 92260
Phone (760) 568-5381

10408 Industrial Cir
Redlands, CA 92374
Phone (909) 796-0363

10408 Industrial Cir
#1112
Redlands, CA 92374
Phone (909) 796-7803

2621 S Bristol St
Ste 202
Santa Ana, CA 92704
Phone (657) 900-4536

41900 Winchester Rd
Ste 102
Temecula, CA 92590
Phone (951) 461-6502

7957 Painter Ave
Ste 104
Whittier, CA 90602
Phone (310) 638-9391

Organizations & group practices 7

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": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1699299073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 ANTON BLVD UNIT 330",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926261998",
            "telephone_number": "310-691-6129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAYLOSIS",
        "first_name": "IVAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-27",
        "last_updated": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "95000862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.