Melissa KS Bautista, MACOM, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC208634 Issued in OR

Practice address

833 SE Main St Ste 323
Portland, OR 97214-3427

Phone

(503) 894-0064

NPI assigned

Dec 23, 2022

Sex

Female

Sole proprietor

Yes

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.

• Premier Care Chiropractic, LLC

  • Chiropractor
  • Portland, OR
  • NPI 1710507348

  Acupuncturist

  NPD (past)
• Premier Care Wellness Company

  • Chiropractor
  • Portland, OR
  • NPI 1053012583

  Acupuncturist

  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1671753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1760194534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3135 SE 89TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97266",
            "telephone_number": "971-226-3539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SE MAIN ST STE 323",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143427",
            "telephone_number": "503-894-0064"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "524 SE 14th Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972142428",
            "country_code": "US",
            "telephone_number": "971-544-7058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "MELISSA",
        "middle_name": "KS",
        "credential": "MACOM, LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-23",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC208634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josefa Bautista Zacarias
• Alison Bautista
• Irina Bautista
• Jessica Lilliana Bautista, NP
• Mary Grace A Bautista, PT
• Cheryl Bauzon, PHARM.D.
• Julianne Bava, NMNP
• Tovia Blair Bavly, DO
• Kelly Clark Bawden, MS, CCC-SLP
• Freda Brigitte Bax, PSY.D.

• All providers in Portland, OR
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.