Active NPI
Juddson Baldwin, PA-C
- Physician Assistant
- Fort Defiance, AZ
National Provider Identifier
1700155124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601006248
- Practice address
- Corner of Route N12 and N7
Fort Defiance, AZ 86504 - Phone
- (616) 262-8856
- NPI assigned
- Dec 14, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601006248 | MI | Primary |
Addresses
Primary practice location
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Mailing address
PO Box 649
Fort Defiance, AZ 86504-0649
Phone (616) 262-8856
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171214002135 | NM | Practitioner - Physician Assistant | 5698934552 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- NNM Gastroenterology Associates PA
Practice addresses (Care Compare)
1691 Galisteo St
Suite C
Santa Fe, NM 87505-4781
Phone (505) 983-5631
Hospital & facility affiliations
- Christus St Vincent Regional Medical Center
- Los Alamos Medical Center
- Holy Cross Hospital a Div of Taos Health Systems
Merit-based Incentive Payment System (MIPS)
- Final score
- 97.11 of 100
- Quality
- 94.22
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601006248 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Taos Health Systems, Inc., Holy Cross Hospital | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Critical Access Hospital
- Taos, NM
- NPI 1902338049
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Taos, NM
- NPI 1194751958
Hospital
-
- Critical Access Hospital
- Taos, NM
- NPI 1902338049
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352332800000",
"number": "1700155124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 649",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "865040649",
"telephone_number": "616-262-8856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CORNER OF ROUTE N12 AND N7",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "86504",
"telephone_number": "616-262-8856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALDWIN",
"first_name": "JUDDSON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-14",
"last_updated": "2012-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601006248",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Defiance, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.