Jason K Boutros M D Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A42891 Issued in CA

Legal business name

JASON K BOUTROS M D INC

Practice address

2750 E Washington Blvd
Suite 260
Pasadena, CA 91107-1448

Phone

(626) 798-8923

Fax

(626) 798-0258

NPI assigned

May 1, 2007

Organization subpart

No

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

Authorized official

Name

Cindy Chon

Title

Administrator

Phone

(626) 798-8923

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason K Boutros, M.D.

  • Specialist
  • Pasadena, CA
  • NPI 1942243563
  Medicare reassignment
• Khai DO, M.D.

  • Internal Medicine Physician
  • Santa Ana, CA
  • NPI 1396939526
  NPD (past)
• Ghassan Khamiseh, M.D.

  • Internal Medicine Physician
  • Long Beach, CA
  • NPI 1710009808
  NPD (past)
• Stan Mathioulakis, MD

  • Internal Medicine Physician
  • Duarte, CA
  • NPI 1912080847
  NPD (past)
• Shura A Moreno, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1174542716
  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296172800000",
    "number": "1053532580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 E WASHINGTON BLVD",
            "address_2": "SUITE 260",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071448",
            "telephone_number": "626-798-8923",
            "fax_number": "626-798-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 E WASHINGTON BLVD",
            "address_2": "SUITE 260",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071448",
            "telephone_number": "626-798-8923",
            "fax_number": "626-798-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON K BOUTROS M D INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2011-01-28",
        "status": "A",
        "authorized_official_last_name": "CHON",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "626-798-8923"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A42891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0076360",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Corazon Jose Jara, RN, PHN
• Nicole H Jaramillo
• Joyti Jariwala
• Jasmeet Gill MD Inc
• Jason C. Braun
• Jason Tzuying Cheng MD, Inc.
• Irina Jasper, MD
• Emily Jastrow, ACSW
• Daiva Rita Jasulaitis, D.D.S.
• Dolores Marie Jauregui

• Internal Medicine Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.