Physician Compare National (NPI:1629115001)

HEALTHCARE PROVIDER: JOHN RANDALL BOUTWELL D.C.,B.C.A.O.

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

Individual Professional Information
NPI	1629115001
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143202127
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130318000346
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOUTWELL
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BOUTWELL CHIROPRACTIC GROUP
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7618959693
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3665 WHEELER RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2A
	Group Practice or individual's line 2 address
City	AUGUSTA
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	309096510
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7068608717
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M