NPIMap

Individual provider Active NPI

Michael M Boustany, MD

  • Surgery Physician
  • South Charleston, WV
National Provider Identifier
1619973096
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
10600 Issued in WV
Practice address
434 Division St
South Charleston, WV 25309
Phone
(304) 766-7140
Fax
(304) 766-7180
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 10600 WV
Surgery Physician 208600000X 10600 WV Primary

Addresses

Primary practice location

434 Division St
South Charleston, WV 25309

Mailing address

4605 Maccorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

Other practice location 1

4605 MacCorkle Ave SW
South Charleston, WV 25309-1311
Phone (304) 414-4800

Other names 1

  • Mohammad M Boustany Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address michael.boustany@thomashealthsystem.direct-ci.com
Direct Messaging Address michael.boustany@thomashealthsystem.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20100902000540 WV Practitioner - General SurgeryPractitioner - Vascular Surgery 4789572736 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10600WVMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
THS Physician Partners Inc Surgery CurrentSince Sep 1, 2017 Accepting new patients

Locations

L3539
Columbus, OH 43260
Phone (304) 414-4800

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

4605 Maccorkle Ave SW
Ofc
South Charleston, WV 25309
Phone (304) 414-4800

434 Division St
South Charleston, WV 25309
Phone (304) 766-6335

Interoperability endpoints

  • Direct secure messaging: michael.boustany@thomashealthsystem.direct-ci.com

Organizations & group practices 1

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.

Hospital & facility affiliations 12

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

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
THS Physician Partners Inc 366 clinicians

Practice addresses (Care Compare)

434 Division St
South Charleston, WV 25309-1443
Phone (304) 766-7140

Hospital & facility affiliations

  • Thomas Memorial Hospital Hospital, South Charleston, WV, CCN 510029
  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy22
Upper gastrointestinal (GI) endoscopy for acid reflux16

NPI Registry JSON

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1619973096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 MACCORKLE AVE SW",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091311",
            "telephone_number": "304-414-4800",
            "fax_number": "304-414-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 DIVISION ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "25309",
            "telephone_number": "304-766-7140",
            "fax_number": "304-766-7180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4605 MacCorkle Ave SW",
            "address_purpose": "LOCATION",
            "city": "South Charleston",
            "state": "WV",
            "postal_code": "253091311",
            "country_code": "US",
            "telephone_number": "304-414-4800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUSTANY",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WV",
            "license": "10600",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WV",
            "license": "10600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.boustany@thomashealthsystem.direct-ci.com",
            "affiliation": "N",
            "address_1": "4605 MacCorkle Ave SW",
            "city": "South Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253091311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.boustany@thomashealthsystem.direct-ci.com",
            "affiliation": "N",
            "address_1": "434 Division St",
            "city": "South Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "25309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MOHAMMAD",
            "last_name": "BOUSTANY",
            "middle_name": "M",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.