Jerry W Bautsch, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12264 Issued in TX

Practice address

2815 W Lake Houston Pkwy
Suite 107
Kingwood, TX 77339-5227

Phone

(281) 361-2011

Fax

(281) 360-6517

NPI assigned

Oct 10, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902993827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2815 W LAKE HOUSTON PKWY",
            "address_2": "SUITE 107",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773395227",
            "telephone_number": "281-361-2011",
            "fax_number": "281-360-6517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 W LAKE HOUSTON PKWY",
            "address_2": "SUITE 107",
            "city": "KINGWOOD",
            "state": "TX",
            "postal_code": "773395227",
            "telephone_number": "281-361-2011",
            "fax_number": "281-360-6517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTSCH",
        "first_name": "JERRY",
        "middle_name": "W",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "12264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kyle Bautsch
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• Michelle Renee Bayne, MA
• Bayou City Medical Toxicology and Emergency Medicine Consultants
• Amanda Bays

• General Practice Dentistry in Kingwood, TX
• Providers in Kingwood, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.