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RAFAEL ERNESTO LEDESMA BILBAO JR. MD
NPI 1164565974
Hospitalist in Grand Rapids, MI

Active since February 14, 2007PECOS EnrolledAccepts Medicare Assignment
200 JEFFERSON AVE SE STE 626, GRAND RAPIDS, MI 49503(616) 685-5576(616) 685-8910 Get Directions Write a Review

NPPES record last updated: April 26, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Rafael Ernesto Ledesma Bilbao Jr. Md NPPES

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

RAFAEL ERNESTO LEDESMA BILBAO JR. MD (NPI 1164565974) is an individual hospitalist provider in Grand Rapids, Michigan, licensed in Michigan (4301082270) and active in the NPI registry since February 2007. He is enrolled in Medicare PECOS, is affiliated with Mercy Health Saint Mary's, and is a graduate of Other (1999).

NPPES Registry Identity

NPI1164565974
Entity TypeIndividualMale
Primary Taxonomy208M00000X
Provider Legal NameRAFAEL ERNESTO LEDESMA BILBAO JR.Credential: MD
Location Address200 JEFFERSON AVE SE STE 626Grand Rapids, MI 49503-4502
Mailing Address200 Jefferson Ave SeGrand Rapids, MI 49503-4502 · (616) 685-5576 · Fax (616) 685-8910
Phone(616) 685-5576
Fax(616) 685-8910
Sole ProprietorNo
Medical School CMSOtherGraduated 1999
Enumeration DateFebruary 14, 2007
Last NPPES UpdateApril 26, 2022
NPPES CertifiedApril 26, 2022
✔ NPI 1164565974 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyHospitalistAllopathic & Osteopathic Physicians
Taxonomy Code208M00000X
License✔ Licensed in MI · 4301082270
Definition
Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.
Also ListedInternal MedicineTaxonomy 207R00000X · License 4301082270 (MI)
200 JEFFERSON AVE SE STE 626, Grand Rapids, MI 49503
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Rafael Ernesto Ledesma Bilbao Jr. Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID1850495136
PECOS Enrollment IDI20070326000416
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

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

Advantage Health Saint Mary's Medical Group
Same address
Multi-Specialty
200 JEFFERSON SE
Grand Rapids, MI 49503
  • Reassigned Medicare billing, Michigan enrollment
  • 737 clinicians in this Medicare group
NPI 1952340911 (616) 685-5000

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

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
194 services82 patients
Hospital discharge day management, more than 30 minutes 99239
Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.
47 services46 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
44 services29 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
20 services20 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
13 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Mercy Health Saint Mary's

Acute Care Hospitals · Grand Rapids, MI
4/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number230059
Location200 Jefferson Avenue SEGrand Rapids, MI 49503 · Kent County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49503 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$126.15 typical visit price
range $54.34 – $166.68
Typical copayment $31.53 (range $13.58 – $41.67)
Most-billed visit code 99204
Established Patient
$96.44 typical visit price
range $17.09 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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 Rafael Bilbao's NPI number?

The NPI number for Rafael Bilbao is 1164565974. It was assigned to this individual provider in the NPPES registry on February 14, 2007.

Where is Rafael Bilbao located?

Rafael Bilbao practices at 200 Jefferson Ave SE Ste 626, Grand Rapids, MI 49503. The listed phone number is (616) 685-5576.

What is Rafael Bilbao's specialty?

The primary specialty registered for this NPI is Hospitalist with taxonomy code 208M00000X.

Is Rafael Bilbao enrolled in Medicare?

Yes. Rafael Bilbao is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Rafael Bilbao's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Rafael Bilbao reassigns Medicare benefits to Advantage Health Saint Mary's Medical Group (Grand Rapids, MI). 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 Rafael Bilbao's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Rafael Bilbao accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 2 other insurers list Rafael Bilbao 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.

Is Rafael Bilbao affiliated with any hospitals?

According to CMS data, Rafael Bilbao is affiliated with Mercy Health Saint Mary's.

When was this NPI record last updated?

The NPPES record for Rafael Bilbao was last updated on April 26, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.