Active NPI
Michelle Boutain, CHW
- Community Health Worker
- Allegan, MI
National Provider Identifier
1023857349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 95396175
- Practice address
- 3255 122ND Ave Ste 200
Allegan, MI 49010-9590 - Phone
- (269) 686-4585
- NPI assigned
- May 24, 2024
- Last updated
- Aug 5, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 95396175 | MI | Primary |
Addresses
Primary practice location
3255 122ND Ave Ste 200
Allegan, MI 49010-9590
Mailing address
3255 122ND Ave Ste 200
Allegan, MI 49010-9590
Phone (269) 686-4585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95396175 | MI | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1023857349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3255 122ND AVE STE 200",
"city": "ALLEGAN",
"state": "MI",
"postal_code": "490109590",
"telephone_number": "269-686-4585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3255 122ND AVE STE 200",
"city": "ALLEGAN",
"state": "MI",
"postal_code": "490109590",
"telephone_number": "269-686-4585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTAIN",
"first_name": "MICHELLE",
"credential": "CHW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-24",
"last_updated": "2024-08-05",
"certification_date": "2024-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "MI",
"license": "95396175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Allegan, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.