Chandel Marie Bouthot, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12091 Issued in CT

Practice address

164 Mount Pleasant Rd Ste 202
Newtown, CT 06470-1477

Phone

(203) 270-1016

NPI assigned

Jun 23, 2023

Last updated

Jan 26, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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 CT, FL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Group practices

Pcma Palliative Division LLCGroup PAC ID 1456613637, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: chandel.bouthot.npi1821774068.phpct@direct.optumcare.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pcma Palliative Division LLC

  dba Pcma Medical Group LLC Sole MBR

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Pittsburgh, PA
  • NPI 1629585054

  FL

  Medicare reassignment Care Compare group NPD
• Prohealth Physicians PC

  • Family Medicine Physician
  • Farmington, CT
  • NPI 1720194053

  Nurse Practitioner

  Medicare reassignment NPD

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1821774068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5231 AVALON DR W",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 MOUNT PLEASANT RD STE 202",
            "city": "NEWTOWN",
            "state": "CT",
            "postal_code": "064701477",
            "telephone_number": "203-270-1016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTHOT",
        "first_name": "CHANDEL",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nyle Bradley Blanck, D.M.D., M.D.S.
• Nicholas Boccarossa, DMD
• Tod Jeffrey Bogdanoff, PSY.D.
• Susan A. Boritz, M.A.
• Valerie Ngangoua Bouhom, DMD
• Tunis Boyce James, MHC
• Kevin F Braun, DDS
• Silvia Stephanie Brescia
• Emma L Breyan, MS. CCC-SLP
• Lindsey Breyan

• Family Nurse Practitioner in Newtown, CT
• Providers in Newtown, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; 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.