Active NPI
Anthony W Boutt MD PC
- Surgery Physician
- Port Huron, MI
National Provider Identifier
1073939732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 4301070173
- Legal business name
- ANTHONY W BOUTT MD PC
- Practice address
- 1522 Pine Grove Ave Ste C
Port Huron, MI 48060-3382 - Phone
- (810) 987-3556
- Fax
- (810) 987-5090
- NPI assigned
- Mar 5, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Anthony W Boutt, M.D.
- Title
- Physician/Owner
- Phone
- (810) 987-3556
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301070173 | MI | Primary |
Addresses
Primary practice location
1522 Pine Grove Ave Ste C
Port Huron, MI 48060-3382
Mailing address
1522 Pine Grove Ave Ste C
Port Huron, MI 48060-3382
Phone (810) 987-3556
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141209000957 | MI | Part B Supplier - Clinic/Group Practice | 9436471141 |
Receives reassigned benefits from 1 practitioner Practice locations: Port Huron, MI |
National Provider Directory
National Provider DirectoryLocations
1522 Pine Grove Ave
Ste C
Port Huron, MI 48060
Phone (810) 987-3390
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393977600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1393977600000",
"number": "1073939732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1522 PINE GROVE AVE STE C",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603382",
"telephone_number": "810-987-3556",
"fax_number": "810-987-5090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1522 PINE GROVE AVE STE C",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603382",
"telephone_number": "810-987-3556",
"fax_number": "810-987-5090"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANTHONY W BOUTT MD PC",
"organizational_subpart": "NO",
"enumeration_date": "2014-03-05",
"last_updated": "2014-03-05",
"status": "A",
"authorized_official_last_name": "BOUTT",
"authorized_official_first_name": "ANTHONY",
"authorized_official_middle_name": "W",
"authorized_official_title_or_position": "PHYSICIAN/OWNER",
"authorized_official_telephone_number": "810-987-3556",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Surgery",
"state": "MI",
"license": "4301070173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; 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.