Active NPI
Matthew Boutelle, DO
- Emergency Medicine Physician
- Farmington Hills, MI
National Provider Identifier
1679403489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 5151017992
- Practice address
- 28050 Grand River Ave
Farmington Hills, MI 48336-5919 - Phone
- (947) 521-8000
- NPI assigned
- May 22, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 5151017992 | MI | Primary |
Addresses
Primary practice location
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Mailing address
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Phone (947) 521-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260606000119 | MI | Order and Referring Only - Emergency Medicine | 6305317702 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5151017992 | MI | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779408000000",
"number": "1679403489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28050 GRAND RIVER AVE",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483365919",
"telephone_number": "947-521-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28050 GRAND RIVER AVE",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483365919",
"telephone_number": "947-521-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTELLE",
"first_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-05-22",
"last_updated": "2026-05-22",
"certification_date": "2026-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "5151017992",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2026; 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.