Clairalyn Lois Baucom, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

0101240222 Issued in VA

Practice address

Kadena Pediatric Clinic
18MDG / SGHQ Unit 5142
Apo, AP 96367-5142

Phone

(315) 630-4542

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Clairalyn Catherine Elliott Former name

Medicare fee-for-service enrollment

Enrolled in MP, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Commonwealth Healthcare Corporation

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saipan, MP
  • NPI 1285858290
  Medicare reassignment NPD
• Mid-Columbia Medical Center

  • General Practice Physician
  • The Dalles, OR
  • NPI 1053409599
  Medicare reassignment NPD
• Commonwealth Healthcare Corporation

  • General Acute Care Hospital
  • Saipan, MP
  • NPI 1871616292
  NPD
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1154351336
  NPD
• Mid-Columbia Medical Center

  • Rural Health Clinic/Center
  • The Dalles, OR
  • NPI 1871833772
  NPD

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221091200000",
    "number": "1760569339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "18MDOS",
            "address_2": "PSC 80 BOX 15477",
            "city": "APO",
            "state": "AP",
            "postal_code": "963675142",
            "telephone_number": "315-630-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "KADENA PEDIATRIC CLINIC",
            "address_2": "18MDG / SGHQ UNIT 5142",
            "city": "APO",
            "state": "AP",
            "postal_code": "963675142",
            "telephone_number": "315-630-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUCOM",
        "first_name": "CLAIRALYN",
        "middle_name": "LOIS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101240222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CLAIRALYN",
            "last_name": "ELLIOTT",
            "middle_name": "CATHERINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.