Individual provider Active NPI

Jimmy Mack Baker, MD

  • Internal Medicine Physician
  • Santa Maria, CA
National Provider Identifier
1912054487
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A44906 Issued in CA
Practice address
2801 Santa Maria Way
Santa Maria, CA 93455-2118
Phone
(805) 934-5400
Fax
(805) 938-9207
NPI assigned
Jan 5, 2007
Last updated
Jun 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A44906 CA Primary

Addresses

Primary practice location

2801 Santa Maria Way
Santa Maria, CA 93455-2118

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8030

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040809001111 CA Practitioner - Internal Medicine 9234101460 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Aug 1, 2017 Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince Aug 1, 2017 Accepting new patients

Locations

150 Tejas Pl
Nipomo, CA 93444
Phone (805) 929-3254

2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014

2801 Santa Maria Way
Santa Maria, CA 93455
Phone (805) 934-5400

2801 Santa Maria Way
Bldg A
Santa Maria, CA 93455
Phone (805) 938-9200

2801 Santa Maria Way
Bldg C
Santa Maria, CA 93455
Phone (805) 934-5400

Organizations & group practices 4

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1912054487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8030",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 SANTA MARIA WAY",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934552118",
            "telephone_number": "805-934-5400",
            "fax_number": "805-938-9207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "JIMMY",
        "middle_name": "MACK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A44906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.