Individual provider Active NPI

Jairo Bastidas, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Bronx, NY
National Provider Identifier
1780763300
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
041328 Issued in NY
Practice address
111 E 210TH St
Bronx, NY 10467-2401
Phone
(718) 920-4167
Fax
(718) 515-5419
NPI assigned
Nov 3, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 041328 NY Primary

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2401

Mailing address

90 Palisade Ave
White Plains, NY 10607-2725
Phone (718) 920-4167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040710000019 NY Practitioner - Maxillofacial Surgery 6709864317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial Surgery
Education
Other, 1987
Medicare assignment
May accept Medicare assignment
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

951 Prospect Ave
Bronx, NY 10459-2967
Phone (718) 860-8440

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041328NYMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center Oral and Maxillofacial Surgery CurrentSince Aug 19, 2012 Accepting new patients
Montefiore Medical Center CurrentSince Aug 19, 2012 Accepting new patients
Montefiore Medical Center Oral and Maxillofacial Surgery Past Accepting new patients
Montefiore Medical Center Past Accepting new patients
Montefiore Dental Department Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

3332 Rochambeau Ave
Fl 2
Bronx, NY 10467
Phone (718) 920-4649

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jbastida@montefioredirect.com

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780763300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 PALISADE AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106072725",
            "telephone_number": "718-920-4167",
            "fax_number": "718-515-5419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-4167",
            "fax_number": "718-515-5419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIDAS",
        "first_name": "JAIRO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "041328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.