NPIMap

Individual provider Active NPI

Nedrana Boutte, M.D.

  • Family Medicine Physician
  • Winnie, TX
National Provider Identifier
1982805586
Registry record updated Jan 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M6974 Issued in TX
Practice address
538 Broadway
Winnie, TX 77665-7600
Phone
(409) 296-9505
Fax
(409) 296-2506
NPI assigned
May 30, 2007
Last updated
Jan 5, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2010

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 M6974 TX Primary

Addresses

Primary practice location

538 Broadway
Winnie, TX 77665-7600

Mailing address

PO Box 714
Winnie, TX 77665-0714
Phone (409) 296-9505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071210000668 TX Practitioner - Family Practice 1850480054 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Thompson Outpatient Clinic, LLCGroup PAC ID 6709837362, 2 clinicians

Practice addresses (Care Compare)

233 Spur
Suite 5
Winnie, TX 77665-7308
Phone (409) 296-2910

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M6974TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thompson Outpatient Clinic, LLC Family Medicine CurrentSince Aug 1, 2007 Accepting new patients
Boutte Family Practice, PLLC Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
Winnie Community Hospital, LLC Past Accepting new patients
Chambers County Past Accepting new patients

Locations

233 Spur 5
Winnie, TX 77665
Phone (409) 296-2910

304 Broadway
Winnie, TX 77665
Phone (409) 286-2910

538 Broadway
Winnie, TX 77665
Phone (409) 296-6000

Interoperability endpoints

  • Direct secure messaging: nboutte@wcrclnd.securechart.com

Organizations & group practices 4

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262649600000",
    "number": "1982805586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 714",
            "city": "WINNIE",
            "state": "TX",
            "postal_code": "776650714",
            "telephone_number": "409-296-9505",
            "fax_number": "409-296-2506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 BROADWAY",
            "city": "WINNIE",
            "state": "TX",
            "postal_code": "776657600",
            "telephone_number": "409-296-9505",
            "fax_number": "409-296-2506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTTE",
        "first_name": "NEDRANA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2010-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M6974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnie, TX

Sources for this page

Verify at the official NPI Registry.