Active NPI
Kerry Mark Bachista, M.D.
- Emergency Medicine Physician
- Jacksonville, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- ME101449
- Practice address
- 4500 San Pablo Rd S
Jacksonville, FL 32224-1865 - Phone
- (904) 953-2000
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | ME101449 | FL | Primary |
| Emergency Medicine Physician | 207P00000X | 60790 | GA | |
| Emergency Medicine Physician | 207P00000X | TRN9208 | FL |
Addresses
Primary practice location
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Mailing address
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000
Other practice location 1
4700 Waters Ave
Savannah, GA 31404-6220
Phone (912) 350-3849
Other practice location 2
200 1st St SW
Rochester, MN 55905-0001
Phone (190) 495-3200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2813769-00 | Medicaid | FL | |
| 41057 | Other | FL | BCBS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kbachista1818786@ehrdirect.mayoclinicmsg.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081006000225 | FL | Practitioner - Emergency Medicine | 2769557446 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000
Hospital & facility affiliations
- Mayo Clinic
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.24 of 100
- Quality
- 74.85
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 72.62
Merit-based Incentive Payment System (MIPS)
- Final score
- 59.59 of 100
- Quality
- 59.93
- Promoting interoperability
- 0
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TRN9208 | FL | MD | Emergency Medicine Physician |
| 60790 | GA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Florida Jacksonville Physicians Inc | Current | Accepting new patients | |
| Mayo Clinic Jacksonville | Current | Accepting new patients | |
| Mayo Clinic Jacksonville | Current | Accepting new patients | |
| University of Florida Jacksonville Physicians Inc | Emergency Medicine | Current | Accepting new patients |
| University of Florida Jacksonville Physicians, Inc. | Current | Accepting new patients | |
| Medexpress Urgent Care of West Boca Raton LLC | Past | Accepting new patients | |
| Darling Emergency Physicians LLC | Emergency Medicine | Past | Accepting new patients |
| Medexpress Urgent Care of Boynton Beach, LLC | Past | Accepting new patients |
Locations
655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680
800 Prudential Dr
Jacksonville, FL 32207
Phone (904) 202-2000
4500 San Pablo Rd S
Jacksonville, FL 32224
Phone (904) 721-4815
410 Darling Ave
Waycross, GA 31501
Phone (912) 283-3030
200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850
Interoperability endpoints
- kbachista59267@direct.shands.ufl.edu
Organizations & group practices 8
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.
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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": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668643200000",
"number": "1891845798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 SAN PABLO RD S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322241865",
"telephone_number": "904-953-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 SAN PABLO RD S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322241865",
"telephone_number": "904-953-2000"
}
],
"practiceLocations": [
{
"address_1": "4700 Waters Ave",
"address_purpose": "LOCATION",
"city": "Savannah",
"state": "GA",
"postal_code": "314046220",
"country_code": "US",
"telephone_number": "912-350-3849",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "200 1st St SW",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "MN",
"postal_code": "559050001",
"country_code": "US",
"telephone_number": "190-495-3200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BACHISTA",
"first_name": "KERRY",
"middle_name": "MARK",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2022-11-17",
"certification_date": "2022-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "FL",
"license": "ME101449",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "GA",
"license": "60790",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "FL",
"license": "TRN9208",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2813769-00",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "41057",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kbachista1818786@ehrdirect.mayoclinicmsg.org",
"affiliation": "N",
"address_1": "4500 San Pablo Rd S",
"city": "Jacksonville",
"state": "FL",
"country_code": "US",
"postal_code": "322241865",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.