Individual provider Active NPI

Cynthia Leigh Baca, MD

  • Pediatrics Physician
  • Hollywood, FL
National Provider Identifier
1841789260
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
T1989 Issued in TX
Practice address
1005 Joe Dimaggio Dr
Hollywood, FL 33021-5402
Phone
(505) 610-9587
NPI assigned
May 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X T1989 TX
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X T1989 TX Primary

Addresses

Primary practice location

1005 Joe Dimaggio Dr
Hollywood, FL 33021-5402

Mailing address

911 Doveplum CT
Hollywood, FL 33019-4873
Phone (505) 610-9587

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20210811002396 TX Practitioner - Pediatric Medicine 7315341476 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
T1989TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Group CurrentSince Aug 9, 2021 Accepting new patients
Covenant Medical Group Pediatrics CurrentSince Aug 9, 2021 Accepting new patients
Midland County Hospital District Past Accepting new patients

Locations

2215 Nashville Ave
Lubbock, TX 79410
Phone (806) 725-5228

400 Rosalind Redfern Grover Pkwy
Ste 281
Midland, TX 79701
Phone (432) 620-5800

400 Rosalind Redfern Grover Pkwy
Midland, TX 79701
Phone (432) 221-4850

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1841789260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 DOVEPLUM CT",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330194873",
            "telephone_number": "505-610-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 JOE DIMAGGIO DR",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215402",
            "telephone_number": "505-610-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACA",
        "first_name": "CYNTHIA",
        "middle_name": "LEIGH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-02",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "T1989",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "T1989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.