NPIMap

Individual provider Active NPI

Dina Youseff Boutros, M.D.

  • Neurology Physician
  • Fairlawn, OH
National Provider Identifier
1295732352
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
35073803 Issued in OH
Practice address
3562 Ridge Park Dr
Ste. a
Fairlawn, OH 44333-9294
Phone
(330) 664-0767
Fax
(330) 664-0766
NPI assigned
Jul 5, 2005
Last updated
Oct 11, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 35073803 OH Primary

Addresses

Primary practice location

3562 Ridge Park Dr
Ste. a
Fairlawn, OH 44333-9294

Mailing address

3562 Ridge Park Dr
Ste. a
Fairlawn, OH 44333-9294
Phone (330) 664-0767

Other identifiers 4

IdentifierTypeStateIssuer
2340087MedicaidOH
2551671OtherOHPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
9338635OtherOHPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
1841239274OtherOHPARTNERS PHYSICIAN GROUP TYPE 2 NPI #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050421001254 OH Practitioner - Neurology 8921046731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

18101 Lorain Ave
Cleveland, OH 44111-5612
Phone (216) 671-2205

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

970 E Washington St
Medina, OH 44256-2181

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35073803OHMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Euclid Hospital Cleveland Clinic Health System Current Accepting new patients
The Cleveland Clinic Foundation CurrentSince Dec 14, 2010 Accepting new patients
JTDM Family Practice LLC Neurology Past Accepting new patients
Neurology and Neuroscience Associates, Inc. Neurology Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Southern Neuroscience Center, PA Neurology Past Accepting new patients
Partners Physician Group Past Accepting new patients
Joint Township District Memorial Hospital Past Accepting new patients
Neurology and Neuroscience Associates Inc Neurology Past Accepting new patients

Locations

224 W Exchange St
Ste 160
Akron, OH 44302
Phone (330) 344-6505

224 W Exchange St
Ste 225
Akron, OH 44302
Phone (330) 344-7400

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

3562 Ridge Park Dr
Ste A
Fairlawn, OH 44333
Phone (330) 664-0767

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

Interoperability endpoints

  • Direct secure messaging: dboutros100135@direct.ccf.org

Organizations & group practices 9

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1295732352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3562 RIDGE PARK DR",
            "address_2": "STE. A",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443339294",
            "telephone_number": "330-664-0767",
            "fax_number": "330-664-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3562 RIDGE PARK DR",
            "address_2": "STE. A",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443339294",
            "telephone_number": "330-664-0767",
            "fax_number": "330-664-0766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "DINA",
        "middle_name": "YOUSEFF",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-05",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "35073803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2340087",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS PHYSICIAN GROUP MEDICAID GROUP #",
            "identifier": "2551671",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS PHYSICIAN GROUP MEDICARE GROUP #",
            "identifier": "9338635",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS PHYSICIAN GROUP TYPE 2 NPI #",
            "identifier": "1841239274",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairlawn, OH

Sources for this page

Verify at the official NPI Registry.