Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carlos Bautista, MD

Individual provider Family Medicine Physician · NPI 1134417272

Carlos Bautista, MD is a Family Practice in Boise, Idaho. Qualified in 2002, 24 years ago. Practices with Reno Sparks Indian Colony, a 17-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
24
Licensed in
NY
In the registry since
2011
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

777 N Raymond St
Boise, ID 83704-9251
Phone: (208) 514-2500
Fax: (208) 375-2217
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 243704-1 (NY)

Record details

NPI number1134417272
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 11, 2011
Last updated in NPPESJuly 11, 2011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Reno Sparks Indian Colony — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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