Martin Leboutillier III, M.D.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

MD065743L Issued in PA

Practice address

Fourth & Walnut STS
2ND FL
Lebanon, PA 17042-1281

Phone

(717) 270-3751

Fax

(717) 270-3754

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Thoracic Surgery

Education

Columbia University College of Physicians and Surgeons, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellspan Vna Home Care Home health agency, York, PA, CCN 397004
• Wellspan Good Samaritan Hospital Hospital, Lebanon, PA, CCN 390066

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ileboutillier51404@wellspan.direct-ci.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.

• Wellspan Medical Group

  dba WellSpan Digestive Health

  • Gastroenterology Physician
  • York, PA
  • NPI 1669770004
  Medicare reassignment Care Compare group NPD
• Wellspan Medical Group

  dba WellSpan Pediatric Surgical Specialist

  • Pediatric Surgery Physician
  • York, PA
  • NPI 1104799428
  NPD
• Wellspan Medical Group

  dba Wellspan Plastic Surgery

  • Plastic and Reconstructive Surgery Physician
  • York, PA
  • NPI 1245490515
  NPD
• The Good Samaritan Hospital of Lebanon, Pennsylvania

  dba WellSpan Good Samaritan Hospital

  • General Acute Care Hospital
  • Lebanon, PA
  • NPI 1407928500
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Good Samaritan Hospital of Lebanon, Pennsylvania

  dba WellSpan Good Samaritan Hospital

  • Ambulatory Surgical Clinic/Center
  • Lebanon, PA
  • NPI 1205902343

  Hospital

  Care Compare affiliation
• The Good Samaritan Hospital of Lebanon, Pennsylvania

  dba WellSpan Good Samaritan Hospital

  • General Acute Care Hospital
  • Lebanon, PA
  • NPI 1407928500
  Care Compare affiliation
• The Good Samaritan Hospital of Lebanon, Pennsylvania

  dba WellSpan Good Samaritan Hospital

  • Emergency Medicine Physician
  • Lebanon, PA
  • NPI 1730754284

  Hospital

  Care Compare affiliation
• Vna Home Health Services

  dba Wellspan VNA Home Care

  • Home Health Agency
  • York, PA
  • NPI 1437172301
  Care Compare affiliation

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468972800000",
    "number": "1831152651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FOURTH & WALNUT STS",
            "address_2": "2ND FL",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170421281",
            "telephone_number": "717-270-3751",
            "fax_number": "717-270-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FOURTH & WALNUT STS",
            "address_2": "2ND FL",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170421281",
            "telephone_number": "717-270-3751",
            "fax_number": "717-270-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBOUTILLIER",
        "first_name": "MARTIN",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2016-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD065743L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058255700",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001708549",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH MERCY-WMG",
            "identifier": "30139141",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "976216",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1511587",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lebanon Valley Foot and Ankle Center
• Lebanon Vamc
• Lebanon Vamc
• Lebanon Vamc
• Lebanon Wellness (Modern Medicine)
• Todd Lecher, M.D.
• Cheryl Ann Lee, MSW, LSW
• Joseph W Lee, BRS
• Najin Lee, M.D.
• Shayla Rae Lee, LSW

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; 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.