Dr Walter Clark Boutwell, MD is a medicare enrolled "Pediatrics - Neonatal-perinatal Medicine" physician in Pike Road, Alabama. His current practice location is
207 Hunter Trl, Pike Road, Alabama. You can reach out to his office (for appointments etc.) via phone at
(334) 657-7198.
Dr Walter Clark Boutwell is licensed to practice in Pennsylvania (license number MD-014439-E) 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 1316908809.
Physician's Profile
| Full Name | Dr Walter Clark Boutwell |
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| Gender | Male |
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| Speciality | Pediatrics - Neonatal-perinatal Medicine |
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| Location | 207 Hunter Trl, Pike Road, Alabama |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1316908809
- Provider Enumeration Date: 04/01/2006
- Last Update Date: 08/28/2012
Medicare PECOS Information:
- PECOS PAC ID: 2961476510
- Enrollment ID: I20160407002145
Medical Identifiers
Medical identifiers for Dr Walter Clark Boutwell such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1316908809 | NPI | - | NPPES |
| 001312743 | Medicaid | CT | |
| 4630520 | Medicaid | MI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2080N0001X | Pediatrics - Neonatal-perinatal Medicine | MD-014439-E (Pennsylvania) | 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. Dr Walter Clark Boutwell allows following entities to bill medicare on his behalf.
| Entity Name | St Alexius Medical Center |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1205868429
PECOS PAC ID: 8426960865
Enrollment ID: O20031104000146 |
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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. Dr Walter Clark 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 |
|---|
Dr Walter Clark Boutwell, MD
207 Hunter Trl,
Pike Road, AL 36064-3415
Ph: (334) 657-7198 | Dr Walter Clark Boutwell, MD
207 Hunter Trl,
Pike Road, AL 36064-3415
Ph: (334) 657-7198 |
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