Individual provider Active NPI

Roger Bautista, D.O.

  • Emergency Medicine Physician
  • Hanford, CA
National Provider Identifier
1902888084
Registry record updated Feb 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OS19273 Issued in FL
Practice address
115 Mall Dr
Hanford, CA 93230-5786
Phone
(559) 582-9000
NPI assigned
Nov 15, 2005
Last updated
Feb 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 42078 CO
Emergency Medicine Physician 207P00000X 70711 GA
Emergency Medicine Physician 207P00000X 20A9319 CA
Emergency Medicine Physician 207P00000X OS19273 FL Primary

Addresses

Primary practice location

115 Mall Dr
Hanford, CA 93230-5786

Mailing address

1601 Cummins Dr Ste D
Modesto, CA 95358-6411
Phone (510) 851-7423

Other practice location 1

9501 Farrell Rd
Fort Belvoir, VA 22060-5901
Phone (703) 805-0599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080929000501 CA Practitioner - Emergency Medicine 3375610652 Reassigns benefits to 1 organization
I20240312000084 FL Practitioner - Emergency Medicine 3375610652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

13139 Sorrento Rd
Pensacola, FL 32507-8777
Phone (850) 746-0020

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A9319CAMDEmergency Medicine Physician
42078COMDEmergency Medicine Physician
70711GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Emergency Medicine Current Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Mar 14, 2024 Accepting new patients
Cep America, LLC Emergency Medicine Current Accepting new patients
Cep America - California Emergency Medicine CurrentSince Oct 1, 2008 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Oct 1, 2008 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Mar 14, 2024 Accepting new patients
Wildwood Sanitarium Incorporated Current Accepting new patients
Anaheim Global Medical Center, Inc Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1025 N Douty St
Hanford, CA 93230
Phone (559) 537-0170

115 Mall Dr
Hanford, CA 93230
Phone (559) 537-0550

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

7800 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 267-1603

13139 Sorrento Rd
Pensacola, FL 32507
Phone (850) 492-0543

435 Life Style Ln
Wildwood, GA 30757
Phone (706) 419-0023

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1902888084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CUMMINS DR STE D",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953586411",
            "telephone_number": "510-851-7423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 MALL DR",
            "city": "HANFORD",
            "state": "CA",
            "postal_code": "932305786",
            "telephone_number": "559-582-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9501 Farrell Rd",
            "address_purpose": "LOCATION",
            "city": "Fort Belvoir",
            "state": "VA",
            "postal_code": "220605901",
            "country_code": "US",
            "telephone_number": "703-805-0599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "ROGER",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "42078",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "70711",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A9319",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "OS19273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanford, CA

Sources for this page

Verify at the official NPI Registry.