Michelle Lynne Boulton, RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

011070-1 Issued in NY

Practice address

171 E. Hoard Street
Watertown, NY 13601-1515

Phone

(315) 786-1767

Fax

(315) 786-1856

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mboulton@hiemail.healtheconnections.org
• Direct secure messaging: michelle.boulton.1@21901.direct.athenahealth.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.

• Carthage Area Hospital Inc

  • Critical Access Hospital
  • Carthage, NY
  • NPI 1053497388
  Medicare reassignment NPD
• Carthage Area Hospital Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Ogdensburg, NY
  • NPI 1013759166
  NPD
• North Country Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Watertown, NY
  • NPI 1609946821
  NPD (past)
• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1336167709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 ARSENAL STREET",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012504",
            "telephone_number": "315-782-9450",
            "fax_number": "315-782-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 E. HOARD STREET",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011515",
            "telephone_number": "315-786-1767",
            "fax_number": "315-786-1856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULTON",
        "first_name": "MICHELLE",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "011070-1",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011070-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leela Krishna Teja Boppana, MBBS
• Meredith Bossinger, DPT
• Stephanie Boswell-Davies, MIDWIFE
• Kaleigh Boulio-Alberry
• Amber Boulrice, RN
• Kellie Lynn Bowhall, LPN
• Richard J Bowles, M.D.
• Gina Brandolino, NP
• Candace Breland, OTR/L
• Kevin Francis Brennan, FNP-C

• Physician Assistant in Watertown, NY
• Providers in Watertown, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.