Individual provider Active NPI

Suzanne Elizabeth Bakke, PA-C

  • Physician Assistant
  • San Luis Obispo, CA
National Provider Identifier
1861676553
Registry record updated Jan 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19533 Issued in CA
Practice address
84 Santa Rosa St
Suite a
San Luis Obispo, CA 93405-5816
Phone
(805) 591-4727
Fax
(805) 439-3394
NPI assigned
Dec 18, 2007
Last updated
Jan 25, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA19533 CA Primary

Addresses

Primary practice location

84 Santa Rosa St
Suite a
San Luis Obispo, CA 93405-5816

Mailing address

84 Santa Rosa St
Ste a
San Luis Obispo, CA 93405-1812
Phone (805) 591-4727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110504000473 CA Practitioner - Physician Assistant 5890970917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care Partners - Slo PCGroup PAC ID 7113203647, 4 clinicians

Practice addresses (Care Compare)

84 Santa Rosa St
San Luis Obispo, CA 93405-1812

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
96.67
Improvement activities
40
Cost
73.69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
19533CAMDChiropractor
PA19533CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatologic Plastic Surgery Clinics of Ca Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: suzanne.bakke.1@14970.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 3

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": "1197936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485302400000",
    "number": "1861676553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 SANTA ROSA ST",
            "address_2": "STE A",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051812",
            "telephone_number": "805-591-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 SANTA ROSA ST",
            "address_2": "SUITE A",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934055816",
            "telephone_number": "805-591-4727",
            "fax_number": "805-439-3394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKKE",
        "first_name": "SUZANNE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-18",
        "last_updated": "2017-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.