Boutros Zeidan, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD064590L Issued in PA

Practice address

315 Locust St
Suite 5B
Johnstown, PA 15901-1651

Phone

(814) 535-2030

Fax

(814) 535-2031

NPI assigned

Sep 6, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pulmonary DiseaseAlso: Sleep Medicine

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Conemaugh Memorial Medical Center Hospital, Johnstown, PA, CCN 390110
• Chan Soon- Shiong Medical Center at Windber Hospital, Windber, PA, CCN 390112

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: boutros.zeidan@3458.securemail.mdnavigatorclinical.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Windber Hospital, Inc.

  dba Windber Medical Center

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• DLP Conemaugh Memorial Medical Center LLC

  dba Conemaugh Memorial Medical Center

  • General Acute Care Hospital
  • Johnstown, PA
  • NPI 1801897038
  Care Compare affiliation
• Windber Hospital, Inc.

  dba Windber Medical Center

  • General Acute Care Hospital
  • Windber, PA
  • NPI 1275620536
  Care Compare affiliation

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294790400000",
    "number": "1043204134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 LOCUST ST",
            "address_2": "SUITE 5B",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159011651",
            "telephone_number": "814-535-2030",
            "fax_number": "814-535-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 LOCUST ST",
            "address_2": "SUITE 5B",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159011651",
            "telephone_number": "814-535-2030",
            "fax_number": "814-535-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEIDAN",
        "first_name": "BOUTROS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2011-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD064590L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "161817",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THREE RIVERS HEALTH PLAN",
            "identifier": "99630",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1507228",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017225930005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann Zayac, LSW
• Hannah Zeanchock
• Marian Zedack
• Kristin Marie Zeek, MA
• Tammy Zeek
• Brittany Ann Zellam, DPT
• Shehui John Zhang, MD
• Kailey Ziemianski, DO
• Kerri Marie Ziesman, RN
• Caleb Zimmerman, NRP

• Specialist in Johnstown, PA
• Providers in Johnstown, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.