Individual provider Active NPI

Scott M Bouton, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Cleveland, OH
National Provider Identifier
1811044167
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
35-084734 Issued in OH
Practice address
11000 Euclid Ave
Cleveland, OH 44106-1714
Phone
(440) 684-5829
Fax
(440) 449-1555
NPI assigned
Jan 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 35-084734 OH Primary

Addresses

Primary practice location

11000 Euclid Ave
Cleveland, OH 44106-1714

Mailing address

3605 Warrensville Center Rd
Shaker HTS, OH 44122-5203
Phone (440) 684-5829

Other identifiers 9

IdentifierTypeStateIssuer
000000337118OtherOHANTHEM
732324OtherOHBUCKEYE
000000221061OtherOHUNISON
363374OtherOHWELLCARE
7288591OtherOHAETNA
2502410OtherOHBCMH
2502410MedicaidOH
1011138340001OtherPAPA MEDICAID
P00412306OtherOHRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20090910000093 NY Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 4183683808 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35-084734OHMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University at Buffalo Pediatric Associates Inc CurrentSince Sep 1, 2009 Accepting new patients
Childrens Research Foundation of Cleveland Pediatric Emergency Medicine Past Accepting new patients

Locations

1001 Main St
Buffalo, NY 14203
Phone (716) 323-0225

1404 Sweet Home Rd
Ste 56
Buffalo, NY 14228
Phone (716) 639-9361

1404 Sweet Home Rd
Buffalo, NY 14228
Phone (716) 932-6060

Organizations & group practices 2

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211241600000",
    "number": "1811044167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 WARRENSVILLE CENTER RD",
            "city": "SHAKER HTS",
            "state": "OH",
            "postal_code": "441225203",
            "telephone_number": "440-684-5829",
            "fax_number": "440-449-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11000 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061714",
            "telephone_number": "440-684-5829",
            "fax_number": "440-449-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTON",
        "first_name": "SCOTT",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "OH",
            "license": "35-084734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000337118",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "732324",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000221061",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "363374",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7288591",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMH",
            "identifier": "2502410",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2502410",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA MEDICAID",
            "identifier": "1011138340001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00412306",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.