NPIMap

Individual provider Active NPI

Adel Boutros, MD

  • Family Medicine Physician
  • Lake Forest, CA
National Provider Identifier
1700952827
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A47792 Issued in CA
Practice address
22611 Lake Forest Dr
Lake Forest, CA 92630-1700
Phone
(949) 951-9399
Fax
(949) 951-9403
NPI assigned
Nov 28, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A47792 CA Primary

Addresses

Primary practice location

22611 Lake Forest Dr
Lake Forest, CA 92630-1700

Mailing address

PO Box 8095
Fountain Valley, CA 92728-8095
Phone (949) 951-9399

Other identifiers 2

IdentifierTypeStateIssuer
00A477921MedicaidCA
A47792OtherCASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
10.66 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
35.54

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. 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 Medicine

State licenses

LicenseStateTypeSpecialty
47792CAMDPharmacist
A47792CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
Acessmd Medical Group, Inc Family Medicine Past Accepting new patients
Anaheim Global Medical Center, Inc Past Accepting new patients
Moulton Family Medicine PastSince Jan 1, 1990 Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
Pacific Neuropsychiatric Specialists Inc. PastSince Jul 19, 2022 Accepting new patients
Alta Newport Hospital, LLC Past Accepting new patients
THC - Orange County LLC Past Accepting new patients
South Coast Global Medical Center, Inc Past Accepting new patients
Moulton Family Medical, Inc. Family Medicine Past Accepting new patients
Market Pharmacy LLC PastSince Jul 1, 2023 Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1700952827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8095",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927288095",
            "telephone_number": "949-951-9399",
            "fax_number": "949-951-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22611 LAKE FOREST DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301700",
            "telephone_number": "949-951-9399",
            "fax_number": "949-951-9403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTROS",
        "first_name": "ADEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A47792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A477921",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A47792",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.