NPIMap

Individual provider Active NPI

Ma Theresa Concepcion Bautista, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Charleston, WV
National Provider Identifier
1780973792
Registry record updated Nov 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
25853 Issued in WV
Practice address
501 Morris St
3 West Administration
Charleston, WV 25301-1326
Phone
(304) 388-3574
Fax
(304) 388-6481
NPI assigned
Mar 30, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 25853 WV Primary

Addresses

Primary practice location

501 Morris St
3 West Administration
Charleston, WV 25301-1326

Mailing address

501 Morris St
Ste 357
Charleston, WV 25301-1326
Phone (304) 388-3574

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140905000730 WV Practitioner - Critical Care (Intensivists) 3678744620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Dec 1, 2015 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Dec 1, 2015 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

501 Morris St
#3W
Charleston, WV 25301
Phone (304) 388-3574

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

3100 Maccorkle Ave SE
Ste 203
Charleston, WV 25304
Phone (304) 345-8820

415 Morris St
Ste 309
Charleston, WV 25301
Phone (304) 348-3290

501 Morris St
Ste 357
Charleston, WV 25301
Phone (304) 388-3574

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

Organizations & group practices 4

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 11

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": "1301443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448323200000",
    "number": "1780973792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MORRIS ST",
            "address_2": "STE 357",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011326",
            "telephone_number": "304-388-3574",
            "fax_number": "304-388-6481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MORRIS ST",
            "address_2": "3 WEST ADMINISTRATION",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011326",
            "telephone_number": "304-388-3574",
            "fax_number": "304-388-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "MA THERESA",
        "middle_name": "CONCEPCION",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-30",
        "last_updated": "2015-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WV",
            "license": "25853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.