Jacque Arlin Boutwell Jr., CFA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

Practice address

3301 County Rd 6 E
Elkhart, IN 46514-7673

Phone

(574) 214-7504

Fax

(574) 262-3214

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416873600000",
    "number": "1013062405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5146 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "574-214-7504",
            "fax_number": "574-262-3214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 COUNTY RD 6 E",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465147673",
            "telephone_number": "574-214-7504",
            "fax_number": "574-262-3214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTWELL",
        "first_name": "JACQUE",
        "middle_name": "ARLIN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CFA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2014-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000577411",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Burton Boron, M.D.
• Heather M. Borsa, RD, CD
• Tyler Borsa, LMFT
• Dawn Boughton
• Mariem Boussaha
• Cheyenne Bowe
• Alexis Rae Bowman, MD
• Kelly Jo Boyer, NP
• Lauren Boyle, LCSW
• Kimberly Ann Boynton, MS CCC-SLP

• Surgical Assistant in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Surgical Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.