Walter Clark Boutwell, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

MD-014439-E Issued in PA

Practice address

207 Hunter TRL
Pike Road, AL 36064-3415

Phone

(334) 657-7198

Fax

(334) 272-4876

NPI assigned

Apr 1, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Pinnacle Health Medical Services

  • Family Medicine Physician
  • Harrisburg, PA
  • NPI 1932143427

  PA

  Medicare reassignment NPD
• Pinnacle Health Medical Services

  • Family Medicine Physician
  • Middletown, PA
  • NPI 1043250384
  NPD
• Pinnacle Health Medical Services

  • Gastroenterology Physician
  • Mechanicsburg, PA
  • NPI 1295552073
  NPD
• Norumbega Medical Specialists, LTD

  • Health Service Clinic/Center
  • Brewer, ME
  • NPI 1780821140
  NPD (past)
• Poplar Bluff Hma Physician Management, LLC

  • Family Medicine Physician
  • Poplar Bluff, MO
  • NPI 1598710147
  NPD (past)
• West Georgia Health Physicians Inc

  • Surgery Physician
  • Lagrange, GA
  • NPI 1164711792
  NPD (past)

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

{
    "created_epoch": "1143849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346112000000",
    "number": "1316908809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HUNTER TRL",
            "city": "PIKE ROAD",
            "state": "AL",
            "postal_code": "360643415",
            "telephone_number": "334-657-7198",
            "fax_number": "334-272-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HUNTER TRL",
            "city": "PIKE ROAD",
            "state": "AL",
            "postal_code": "360643415",
            "telephone_number": "334-657-7198",
            "fax_number": "334-272-4876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTWELL",
        "first_name": "WALTER",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-01",
        "last_updated": "2012-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "PA",
            "license": "MD-014439-E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001312743",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4630520",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaeshon Baldwin
• Benchmark Physical Therapy of Alabama, LLC
• David F Bicard, BCBA-D, LBA
• Jennifer Morgan Billingsley Richardson, DMD
• Kathy Willcutt Bonds, LPC
• Rebecca Rose Burson, D.O.
• Craig Lopas Bynum, LPC
• Heather Sutphen Campbell, MS, RD, LD
• Vincent Pompeo Cappelluzzo, M.D.
• Joshua Therman Davis, PHARMD

• All providers in Pike Road, AL
• Neonatal-Perinatal Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.