Spencer Blake Bouton, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9111708 Issued in FL

Practice address

1540 S Tamiami TRL Ste 303
Sarasota, FL 34239-2921

Phone

(941) 917-8791

Fax

(941) 917-8793

NPI assigned

Oct 9, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SMH Physician Services IncGroup PAC ID 1355240177, 781 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: spencer.bouton@fpg.directbygreenway.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.

• SMH Physician Services Inc

  • Internal Medicine Physician
  • Sarasota, FL
  • NPI 1346295292

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• SMH Physician Services Inc

  • Neurology Physician
  • Sarasota, FL
  • NPI 1730688185
  NPD
• SMH Physician Services Inc

  • Gynecology Physician
  • Sarasota, FL
  • NPI 1275525826
  NPD (past)

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551657600000",
    "number": "1699240465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863407",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328863407",
            "telephone_number": "941-917-2600",
            "fax_number": "941-917-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 S TAMIAMI TRL STE 303",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342392921",
            "telephone_number": "941-917-8791",
            "fax_number": "941-917-8793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTON",
        "first_name": "SPENCER",
        "middle_name": "BLAKE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-09",
        "last_updated": "2019-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9111708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miroslava Plamenova Bounardjieva, DMD
• Ashley Bourcier
• Rene S Bourdeau, PT
• Brandon Esteban Bourgeois, PA-C
• Julia Marie Bourguignon, DO
• Steven Bovio, OD
• Craig Matthew Bow, D.C.
• Eric Bowden
• Kristin Bower, RCSWI
• Phyllis Hannah Bowers Parker, PHD, LMFT

• Physician Assistant in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; 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.