Mina Boutrous, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

064496 Issued in CT

Practice address

6400 Fannin St
Suite 2850
Houston, TX 77030-1521

Phone

(713) 486-5100

NPI assigned

Jan 19, 2014

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Vascular Surgery

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Connecticut Health CenterGroup PAC ID 3678472016, 624 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• John Dempsey Hospital of the University of Connect Hospital, Farmington, CT, CCN 070036

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mboutros37200@direct.med.uchc.edu

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.

• University of Connecticut Health Center

  dba University Physicians

  • General Practice Physician
  • Farmington, CT
  • NPI 1720083769
  Medicare reassignment Care Compare group NPD
• University of Connecticut Health Center

  dba University Physicians

  • Durable Medical Equipment & Medical Supplies
  • Farmington, CT
  • NPI 1104809375
  NPD
• University of Connecticut Health Center

  • Clinical Medical Laboratory
  • Farmington, CT
  • NPI 1427031293
  NPD (past)

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

• John Dempsey Hospital at Solnit - South Campus

  • Psychiatric Hospital Unit
  • Middletown, CT
  • NPI 1154263713
  Care Compare affiliation
• State of Connecticut

  • General Acute Care Hospital
  • Farmington, CT
  • NPI 1669466561
  Care Compare affiliation

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

{
    "created_epoch": "1390089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1619399060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 FANNIN ST",
            "address_2": "SUITE 2850",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301521",
            "telephone_number": "713-486-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 FANNIN ST",
            "address_2": "SUITE 2850",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770301521",
            "telephone_number": "713-486-5100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "263 Farmington Ave",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "CT",
            "postal_code": "060300001",
            "country_code": "US",
            "telephone_number": "860-679-8080",
            "fax_number": "860-679-1430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUTROUS",
        "first_name": "MINA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-19",
        "last_updated": "2022-09-28",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CT",
            "license": "064496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mboutros37200@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "Uconn Medical Group",
            "address_2": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• George Boutros, M.D.
• Michael Boutros
• Boutros, PA
• Samiha Boutros, MA, LPC
• Sean Boutros, MD
• Caleb James Boutte
• Dykie Boutte
• Parys Seymonne Boutte, FNP-C
• Patrina Boutte, CRNA
• Susan Marie Boutte, NP

• Vascular Surgery Physician in Houston, TX
• Providers in Houston, TX by specialty
• Vascular Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.