Boutique Breast Imaging, LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

BOUTIQUE BREAST IMAGING, LLC

Practice address

6871 Belfort Oaks PL
Jacksonville, FL 32216-6242

Phone

(904) 553-8806

NPI assigned

Sep 28, 2023

Organization subpart

No

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

Authorized official

Name

Kathryn Pearson Peyton, MD

Title

Manager

Phone

(904) 553-8806

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kathryn Pearson, MD

  • Diagnostic Radiology Physician
  • Jacksonville, FL
  • NPI 1760403182
  Medicare reassignment NPD

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

{
    "created_epoch": "1695859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1952180887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 WATERMAN RD N",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075240",
            "telephone_number": "904-553-8806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6871 BELFORT OAKS PL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166242",
            "telephone_number": "904-553-8806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUTIQUE BREAST IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-28",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "PEYTON",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "PEARSON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-553-8806",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Bourn, PHARMD
• Michael Blair Bourquin, RPH
• Rachel Bousquet, FNP-BC
• Hannah Marie Boustany, PA-C
• Bradley Scott Boutcher, PA-C
• Michelle Boutron, BCBA
• Roberto Bouzas
• David Bovee Jr., PTA
• Kyle R Bovee
• Katelin Bowater

• Diagnostic Radiology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.