Chad Ryan Bouterse, D.O.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

OP60127012 Issued in WA

Practice address

500 Port Dr
Clarkston, WA 99403-1835

Phone

(509) 758-8811

Fax

(509) 751-1188

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in WA, ID2 enrollments

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 2

Specialty

Ophthalmology

Education

Michigan State University College of Osteopathic Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care Specialists PSGroup PAC ID 3779473723, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.67 of 100Reported as group

Quality

97.26

Promoting interoperability

99

Improvement activities

40

Cost

82.46

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Eye Care Specialists PS

  • Ophthalmology Physician
  • Clarkston, WA
  • NPI 1639160450

  ID

  Medicare reassignment Care Compare group
• Eye Care Specialists PS

  • Ambulatory Surgical Clinic/Center
  • Clarkston, WA
  • NPI 1376556514

  Ophthalmology

  NPD
• Corneal Associates of New Jersey

  • Ophthalmology Physician
  • West Orange, NJ
  • NPI 1437103991
  NPD (past)
• Omni Eye Specialists P a

  • Ophthalmology Physician
  • Iselin, NJ
  • NPI 1376593863
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275004800000",
    "number": "1699896167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PORT DR",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994031835",
            "telephone_number": "509-758-8811",
            "fax_number": "509-751-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PORT DR",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994031835",
            "telephone_number": "509-758-8811",
            "fax_number": "509-751-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTERSE",
        "first_name": "CHAD",
        "middle_name": "RYAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2010-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "5101016467",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "OP60127012",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "O 570",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASURIS - CLARKSTON",
            "identifier": "0080BO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLUE CROSS",
            "identifier": "1699896167",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID - PULLMAN",
            "identifier": "808567101",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON LABOR & INDUSTRY",
            "identifier": "258958",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID - CLARKSTON",
            "identifier": "808567100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "1699896167",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASURIS - PULLMAN",
            "identifier": "0081BO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "O 0570",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OP60127012",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "1699896167",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "1699896167",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8564387",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blue Mountain Family Health PLLC
• Jace Blume
• Trudy Bly, RN,CDE
• Herbert Bohner, RPH
• Maggie Rosalie Bolon, LCSW
• Megan McKenna Brame, RDH
• Sarah Rachel Bramell, RN
• Kendall Jeanne Brenton, PHARMD
• Brian a Howlett Chiropractic a Professional Corporation
• Jessica Bringman, CNP

• Ophthalmology Physician in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; 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.