Matthew Jay Boutin

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN156068 Issued in AZ

Practice address

6445 E 42ND St
Tucson, AZ 85730-3603

Phone

(520) 603-4286

NPI assigned

Nov 10, 2023

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

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Connections Southernaz, LLCGroup PAC ID 2769874197, 25 clinicians

Codac Health Recovery and WellnessGroup PAC ID 6103813811, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: matthew.boutin.p1@direct.codachrw.nextgenshare.com
• Direct secure messaging: matthew.boutin@mmconnections.contexture.medalliesmail.com
• Direct secure messaging: matthew.boutin@mmcodachrw.contexture.medalliesmail.com

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

• Codac Health Recovery and Wellness

  • Community/Behavioral Health Agency
  • Tucson, AZ
  • NPI 1033156567
  Medicare reassignment Care Compare group NPD
• Connections Southernaz, LLC

  dba CRC-Outpatient Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tucson, AZ
  • NPI 1982362943
  Medicare reassignment Care Compare group NPD
• Codac Health Recovery and Wellness

  dba CODAC at Speedway

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1649911157
  NPD
• Codac Health, Recovery & Wellness, Inc.

  dba Las Amigas

  • Adult Mental Health Clinic/Center
  • Tucson, AZ
  • NPI 1467475434
  NPD
• Connections Southernaz, LLC

  dba Crisis Response Center

  • Psychiatry Physician
  • Tucson, AZ
  • NPI 1871203463
  NPD

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

{
    "created_epoch": "1699574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699574400000",
    "number": "1104690064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6445 E 42ND ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857303603",
            "telephone_number": "520-603-4286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6445 E 42ND ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857303603",
            "telephone_number": "520-603-4286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTIN",
        "first_name": "MATTHEW",
        "middle_name": "JAY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-10",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "RN156068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Michael Bourg, MD
• Seda Bourikian, MD
• Adam Bourland
• Stephanie Bourn-Macdonald, AUD
• Christina Bourne, M.D.
• Rory Michael Bouzigard, M.D.
• Bernadette Angelina Bova-Hickey, RN
• Anne Markey Bowen
• Brady John Bowen, D.O.
• Brittany Bowen, LPC

• Psychiatric/Mental Health Nurse Practitioner in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; 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.