Raja B Boutros, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

A499730 Issued in CA

Practice address

25485 Medical Center Dr
#208
Murrieta, CA 92562

Phone

(951) 696-1818

Fax

(951) 696-2939

NPI assigned

Sep 6, 2006

Sex

Male

Sole proprietor

No

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 CA

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

Neurology

Education

Un of California, Irvine, College of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CGEIBA/Endpoint/CGEIBA

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.

• Neurocenter Medical Clinic Inc

  • Neurology Physician
  • Murrieta, CA
  • NPI 1770685968
  Medicare reassignment Authorized official
• Universal Health Services of Rancho Springs Inc

  • General Acute Care Hospital
  • Murrieta, CA
  • NPI 1245221050
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1265535199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O BOX 2770",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925932770",
            "telephone_number": "951-696-1818",
            "fax_number": "951-696-2939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25485 MEDICAL CENTER DR",
            "address_2": "#208",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "92562",
            "telephone_number": "951-696-1818",
            "fax_number": "951-696-2939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "RAJA",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A499730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL GROUP #",
            "identifier": "GR0091910",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFICARE ID#",
            "identifier": "90050380",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0693834",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID#",
            "identifier": "00A499730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsie M Borden
• Chloe Borell, PT
• Susan Carol Bottino
• Yvonne Ann Boudevin, LCSW
• Danielle Boudreaux-Haggerty, MA, LMFT
• Samara Grace Boutwell
• Brayden Matthew Bowers
• Seleste Bowers, LCSW
• Shannon Marie Boyd-Ellington, NP
• Ryan Boyer

• Neurology Physician in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.