Andre Bautista (NPI# 1164665444, PAC ID# 0547573263) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1164665444 |
| PAC ID by PECOS | 0547573263 |
| Professional Enrollment ID | I20150723007521 |
| Full Name | Andre Bautista |
| Organization Legal Name | TRA-MINW, PS |
| Address |
1455 Battersby Ave Enumclaw WA 98022-3634 |
| Phone Number | 2537614200 |
| Gender | M |
| Graduation Year | 2009 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Secondary Specialties | INTERVENTIONAL RADIOLOGY |
| Group Practice PAC ID | 2163316167 |
| Number of Group Practice Members | 102 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 500129 | TACOMA GENERAL ALLENMORE HOSPITAL |
| 500021 | ST CLARE HOSPITAL |
| 500108 | ST JOSEPH MEDICAL CENTER |
| 500151 | ST ANTHONY HOSPITAL |
| 500141 | ST FRANCIS COMMUNITY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1455 Battersby Ave, Enumclaw, WA 98022-3634 | 2537614200 | TRA-MINW, PS |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| MIPS_EC_145_overall | Radiology: Exposure Dose or Time Reported for Procedures Using Fluoroscopy | 98% |
| Organization Legal Name | TRA-MINW, PS |
| Physicians | 106 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Trevor Lee Reeves | Physician Assistant | Tra-minw, Ps | 3402 S 18th St, Tacoma, WA 98405-1903 |
| Evan Michael Leitz | Diagnostic Radiology | Tra-minw, Ps | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1900 |
| Jana Lynn Fahmy | Diagnostic Radiology | Tra-minw, Ps | 2502 S Union Ave, Tacoma, WA 98405-1328 |
| Scott Randall Henneman | Diagnostic Radiology | Tra-minw, Ps | 34515 9th Ave S, Federal Way, WA 98003-6761 |
| Michael Jon Flamoe | Physician Assistant | Tra-minw, Ps | 34515 9th Ave S, Federal Way, WA 98003-6761 |
| Joshua Scott Meyer | Physician Assistant | Tra-minw, Ps | 407 14th Ave Se, Puyallup, WA 98372-3770 |
| David Harold Rice | Diagnostic Radiology | Tra-minw, Ps | 34515 9th Ave S, Federal Way, WA 98003-6761 |
| Chuck D Martin | Diagnostic Radiology | Tra-minw, Ps | 34515 9th Ave S, Federal Way, WA 98003-6761 |
| Rachael Marie Edwards | Diagnostic Radiology | Tra-minw, Ps | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1900 |
| John Paul Kim | Diagnostic Radiology | Tra-minw, Ps | 1304 Fawcett Ave, Suite 100, Tacoma, WA 98402-1900 |
| Street Address |
1455 BATTERSBY AVE |
| City | ENUMCLAW |
| State | WA |
| Zip | 98022-3634 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Benjamin Harrison | Emergency Medicine | Northwest Emergency Physicians LLC | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Patrick N Bacon | Diagnostic Radiology | Tra-minw, Ps | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Jarvis Chung Chen | Diagnostic Radiology | Tra-minw, Ps | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Blesserene P Kazacos | Emergency Medicine | Northwest Emergency Physicians LLC | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Jamie L Collings | Emergency Medicine | Northwest Emergency Physicians LLC | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Sydney Hindley | Emergency Medicine | Northwest Emergency Physicians LLC | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Gouri Bhawan Pothini | Emergency Medicine | Northwest Emergency Physicians LLC | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Katisha Denise Eng | Emergency Medicine | Northwest Emergency Physicians LLC | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Ata Alijani | Diagnostic Radiology | Tra-minw, Ps | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Marvin Bradley Griffin | Emergency Medicine | Northwest Emergency Physicians LLC | 1455 Battersby Ave, Enumclaw, WA 98022-3634 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Daniel Brighton Thompson | Chiropractic | 1624 Pioneer St A, Enumclaw, WA 98022-2299 | |
| Mark A Seaburg | Optometry | 2823 Griffin Ave, Enumclaw, WA 98022-2322 | |
| Paul Shepherd | Optometry | Enumclaw Family Optometry Clinic Ps | 2726 Griffin Ave, Suite B, Enumclaw, WA 98022-2362 |
| Peter L Erickson | Physical Therapy | Performance Sports and Spine Physical Therapy Ps | 2726 Griffin Ave C, Enumclaw, WA 98022-2362 |
| Michael Leigh Beall | Chiropractic | Howells Chiropractic LLC | 2726 Griffin Ave, Suite A, Enumclaw, WA 98022-2362 |
| Anthony J Howells | Chiropractic | Howells Chiropractic LLC | 2726 Griffin Ave, Suite A, Enumclaw, WA 98022-2362 |
| Alexander Shepherd | Optometry | Enumclaw Family Optometry Clinic Ps | 2726 Griffin Ave, Suite B, Enumclaw, WA 98022-2362 |
| Jonathan E Erickson | Physical Therapy | Performance Sports and Spine Physical Therapy Ps | 2726 Griffin Ave C, Enumclaw, WA 98022-2362 |
| Kashish Goyal | Family Medicine | Franciscan Medical Group | 3021 Griffin Ave, Enumclaw, WA 98022-2369 |
| Joy Y Chang | Nurse Practitioner | Franciscan Medical Group | 3021 Griffin Ave, Enumclaw, WA 98022-2369 |
| Find all physicians in zip 98022 | |||
| City | ENUMCLAW |
| Zip Code | 98022 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | ENUMCLAW + DIAGNOSTIC RADIOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.