Bouloute Healthcare Services, LLC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

01303301212 Issued in VA

Legal business name

BOULOUTE HEALTHCARE SERVICES, LLC

Practice address

5049 Anchorstone Dr
Woodbridge, VA 22192-8320

Phone

(678) 517-4214

NPI assigned

Aug 25, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Owmy Bouloute, DPMNPI 1093013880

Title

Owner

Phone

(678) 517-4214

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

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

• Owmy Bouloute, DPM

  • Podiatrist
  • Woodbridge, VA
  • NPI 1093013880
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503619200000",
    "number": "1104343532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8653 16TH ST UNIT 7186",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209077909",
            "telephone_number": "678-517-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5049 ANCHORSTONE DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928320",
            "telephone_number": "678-517-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULOUTE HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2017-08-25",
        "status": "A",
        "authorized_official_last_name": "BOULOUTE",
        "authorized_official_first_name": "OWMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-517-4214",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "VA",
            "license": "01303301212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahmed Boraey
• Michael Howard Borash, LPC
• Michel Bornacelly Perez, M.D.
• Erika Patricia Borrayo, PHD
• James Robert Boudreau, DMD
• Owmy Bouloute, DPM
• Farishta Boura, MD
• Mariya Bourget, M.D.
• Sam Bowmer, M.S.W. , L.C.S.W.
• Michelle Lynn Boyd

• Podiatrist in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Podiatrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2017; 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.