Active NPI
Matthew Howard Boutte, PA-C, MPAS
- Physician Assistant
- Brenham, TX
National Provider Identifier
1457589558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA09060
- Practice address
- 700 Medical Pkwy
Brenham, TX 77833-5413 - Phone
- (979) 337-5000
- NPI assigned
- Jun 26, 2009
- Last updated
- Jun 4, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MA053903 | PA | |
| Physician Assistant | 363A00000X | PA09060 | TX | Primary |
Addresses
Primary practice location
700 Medical Pkwy
Brenham, TX 77833-5413
Mailing address
PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-2111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433376000000",
"number": "1457589558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 844658",
"city": "DALLAS",
"state": "TX",
"postal_code": "752844658",
"telephone_number": "254-724-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 MEDICAL PKWY",
"city": "BRENHAM",
"state": "TX",
"postal_code": "778335413",
"telephone_number": "979-337-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTTE",
"first_name": "MATTHEW",
"middle_name": "HOWARD",
"credential": "PA-C, MPAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-26",
"last_updated": "2015-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PA",
"license": "MA053903",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA09060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brenham, TX
- Bluebonnet Haven, LLC
- Bluebonnet Pediatric Dentistry PLLC (Bluebonnet Pediatric Dentistry)
- Sandra Kay Blum
- Jon F Bode, MD
- Rachel Lynn Boer, PHARMD
- Brandon Guillory OD
- Brazos Valley Apex Pain Specialists PLLC
- Brazos Valley Cancer Clinics, PLLC
- Brazos Valley Mental Health and Wellness, LLC
- Brenham Anesthesia Associates PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; 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.