Physician Compare National (NPI:1093013880)

HEALTHCARE PROVIDER: OWMY BOULOUTE DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1093013880
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042495608
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200421000855
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOULOUTE
	Individual professional last name
Provider First Name	OWMY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	7120 BRADDOCK RD
	Group Practice or individual's line 1 address
City	ANNANDALE
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	220036007
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y