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Dr. Mario Bautista , MD

Pediatrics • Jackson, OH

Active NPI 1619955192 Individual Practitioner Male Practitioner
Practice location in NPPES

1000 Veterans Dr
Jackson, OH 456409586

Call 7403958090 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

1000 Veterans Dr

Jackson, OH 456409586

Telephone 7403958090
Fax 7403958197
Organization at the Same NPPES Address or Phone
Adena Health System Facility NPI 1457538324

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Industry payments (Open Payments)

Fewer than 11 payment records totaling $123.87 in 2023

Drug and medical device companies must report certain payments to doctors and some other clinicians to CMS, such as meals, travel, speaking fees or research funding.

These records are submitted by drug and medical device companies, and a reported payment does not necessarily mean the financial relationship is improper.

General: payments not tied to research, such as meals, travel, consulting or speaking fees.

A reported payment does not necessarily mean the financial relationship is improper. Research payments can go to a hospital or university for a study the clinician leads, not to the clinician personally. Clinicians can dispute records with the company that reported them.

Source: CMS Open Payments, program year 2023.

Guide: How to read an Open Payments record

NPI first issued

2006

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Jackson and Ohio

2 active clinicians are listed under Pediatrics with a practice address in Jackson, OH (2,972 in Ohio).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Open Payments (2023), CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo · Report an error.

Pharma & Medical Device Financial Disclosures

Payments and other transfers of value that drug and medical device companies reported to CMS Open Payments

Open Payments · Program Year 2023
Disclosure Year:

Program year 2023 (payments made January 1 – December 31, 2023): fewer than 11 records totaling $123.87.

Manufacturer Payment Nature Product Type Amount ($)
MEDLINE INDUSTRIES LP
Food and Beverage
In-kind items and services
— General $123.87

Source: CMS Open Payments, program year 2023, released June 30, 2026.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2020-11-25
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

License # reported to NPPES OH 35.089012

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

License # reported to NPPES NM 2004-0547

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics - Pediatric Emergency Medicine

NUCC Taxonomy Code: 2080P0204X

License # reported to NPPES NM 2004-0547

A pediatrician who has special qualifications to manage emergencies in infants and children.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: State Medical Board of Ohio.
Look Up on State Board Site

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid ID
99238071 (NM)
Medicaid ID
2711211 (OH)
Other Identifier Molina
PROVP11655 (NM)
Other Identifier Presbyterian Health/salud
201047701 (NM)
Other Identifier Ahcccs
885808 (AZ)
Other Identifier Lovelace Health/salud
10016535 (NM)
Other Identifier Bc/bs
NM009R63 (NM)
Other Identifier Railroad Medicare
P00137209

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

7 listed
NPI 1184990368

Doctor of Osteopathic Medicine (D.O.)

Jennifer Duncan , CNP

Nurse Practitioner - Family

NPI 1710291604

Certified Nurse Practitioner

Alicia Kammler , CNP

Nurse Practitioner

NPI 1407841992

Certified Nurse Practitioner

Susan Lykins , CNP

Nurse Practitioner - Family

NPI 1154673721

Certified Nurse Practitioner

Dr. Stephen Owen , DO

Family Medicine

NPI 1205854353

Doctor of Osteopathic Medicine (D.O.)

Kara Roof , CNP

Nurse Practitioner - Family

NPI 1972965697

Certified Nurse Practitioner

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events
📍
Updated Practice Location March 22, 2019

Registered at 1000 VETERANS DR, JACKSON, OH 456409586 (Tel: 7403958090)

📍
Updated Business Mailing Address March 22, 2019

Registered at 272 HOSPITAL RD STE 6, CHILLICOTHE, OH 456019031 (Tel: 7407794275)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 22, 2019

Pediatrics (license number reported to NPPES: OH 35.089012)

✅
NPI Profile Active November 02, 2011

NPI status registered as active in NPPES database

📍
Practice Location (Initial Record) November 02, 2011

Registered at 102 TWIN OAKS DR, JACKSON, OH 456409506 (Tel: 7402860469)

📍
Business Mailing Address (Initial Record) November 02, 2011

Registered at 102 TWIN OAKS DR, JACKSON, OH 456409506 (Tel: 7402860469)

👤
Provider Name / Credentials (Initial Record) November 02, 2011

Recorded as MARIO BAUTISTA, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) November 02, 2011

Pediatrics (license number reported to NPPES: OH 35.089012)

🟢
Initial NPI Registration & Enumeration January 05, 2006

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1619955192
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 05, 2006
Last Update: November 25, 2020
Sole Proprietor: No

Mailing Address

272 Hospital Rd Ste 6

Chillicothe, OH 456019031

Phone: 7407794275

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.