Mr Justin Boutwell, PA is a medicare enrolled "Physician Assistant - Medical" in Broken Bow, Nebraska. His current practice location is
145 Memorial Dr, Broken Bow, Nebraska. You can reach out to his office (for appointments etc.) via phone at
(308) 872-2486.
Mr Justin Boutwell is licensed to practice in Nebraska (license number 2387) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1861959017.
Provider's Profile
| Full Name | Mr Justin Boutwell |
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| Gender | Male |
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| Speciality | Physician Assistant - Medical |
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| Location | 145 Memorial Dr, Broken Bow, Nebraska |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1861959017
- Provider Enumeration Date: 02/25/2019
- Last Update Date: 08/19/2019
Medicare PECOS Information:
- PECOS PAC ID: 9234467309
- Enrollment ID: I20190827004075
Medical Identifiers
Medical identifiers for Mr Justin Boutwell such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1861959017 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 363AM0700X | Physician Assistant - Medical | 2387 (Nebraska) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Justin Boutwell allows following entities to bill medicare on his behalf.
| Entity Name | Phelps Memorial Health Center |
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| Entity Type | Part A Provider - Critical Access Hospital |
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| Entity Identifiers | NPI Number: 1629035936 PECOS PAC ID: 9931011947 Enrollment ID: O20071129000753 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Justin Boutwell is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Mr Justin Boutwell, PA 145 Memorial Dr, Broken Bow, NE 68822-1378 Ph: (308) 991-4571 | Mr Justin Boutwell, PA 145 Memorial Dr, Broken Bow, NE 68822-1378 Ph: (308) 872-2486 |
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