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MICAH S BAUTISTA RDN
NPI 1164175063
Dietitian, Registered in Modesto, CA

Active since January 31, 2022
600 COFFEE RD, MODESTO, CA 95355(209) 550-4747 Get Directions Write a Review

NPPES record last updated: February 7, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 7, 2023, Jan 31, 2022 (2 updates tracked since 2022).

About Micah S Bautista Rdn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICAH S BAUTISTA RDN (NPI 1164175063) is an individual dietitian, registered in Modesto, California, licensed in California (86289720) and active in the NPI registry since January 2022. She maintains a secondary practice location in Modesto.

NPPES Registry Identity

NPI1164175063
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameMICAH S BAUTISTACredential: RDN
Location Address600 COFFEE RDModesto, CA 95355-4201
Mailing Address4601 Dale RdModesto, CA 95356-9718 · (209) 735-5000
Phone(209) 550-4747
Sole ProprietorNo
Enumeration DateJanuary 31, 2022
Last NPPES UpdateFebruary 7, 20232 updates tracked since enumeration
NPPES CertifiedFebruary 7, 2023
✔ NPI 1164175063 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers
Taxonomy Code133V00000X
License✔ Licensed in CA · 86289720
Definition
A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.
600 COFFEE RD, Modesto, CA 95355
Open in Google Maps ↗

Secondary Practice Location 1

Location 14601 Dale RdModesto, CA 95356-9718 · Phone (209) 735-5000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Micah S Bautista Rdn is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Micah Bautista reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sutter Valley Medical Foundation
Same address
Multi-Specialty
600 COFFEE RD
Modesto, CA 95355
  • Reassigned Medicare billing, California enrollment
  • 3,056 clinicians in this Medicare group
NPI 1669846986 (209) 524-1211

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RADHA CHIRUMAMILLA M.D.
Hospitalist
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 524-1211
CYRUS M RABII MD
Emergency Medicine
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-6097
RONALD D. JENSEN DPM
Podiatrist
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 524-1211
WALLACE B CARROLL MD
Allergy & Immunology (Allergy)
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 524-1211
PALLAVI SHARMA MD
Family Medicine
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 521-6097
SWE THAN M.D.,PH.D
Internal Medicine
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 550-4702
VIVIAN L TAN M.D.
Anesthesiology
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 524-1211
KENNETH IMANAKA MD
Anesthesiology
600 COFFEE RD
MODESTO, CA 95355
Stanislaus County (209) 524-1211

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Micah Bautista's NPI number?

The NPI number for Micah Bautista is 1164175063. It was assigned to this individual provider in the NPPES registry on January 31, 2022.

Where is Micah Bautista located?

Micah Bautista practices at 600 Coffee Rd, Modesto, CA 95355. The listed phone number is (209) 550-4747.

What is Micah Bautista's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Micah Bautista enrolled in Medicare?

Yes. Micah Bautista is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Micah Bautista's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Micah Bautista reassigns Medicare benefits to Sutter Valley Medical Foundation (Modesto, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Micah Bautista's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Micah Bautista accept?

Health plans from Blue Cross and Blue Shield of Texas list Micah Bautista as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Micah Bautista was last updated on February 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.