JASON K BOUTROS M D INC
NPI 1053532580
Internal Medicine in Pasadena, CA

Q: What is Jason K Boutros M D Inc's NPI number?

The NPI number for Jason K Boutros M D Inc is 1053532580. It was assigned to this organization in the NPPES registry on May 1, 2007.

Q: What is Jason K Boutros M D Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Active since May 01, 2007CLIA 05D0906600 · Waiver

2750 E WASHINGTON BLVD, SUITE 260, PASADENA, CA 91107(626) 798-8923(626) 798-0258 Get Directions Write a Review

NPPES record last updated: January 28, 2011. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Jason K Boutros M D Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JASON K BOUTROS M D INC (NPI 1053532580) is a healthcare organization registered as an internal medicine in Pasadena, California and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through October 2, 2027 and lists Cindy Chon, Administrator, as its authorized official.

NPPES Registry Identity

NPI1053532580

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameJASON K BOUTROS M D INC

Location Address2750 E WASHINGTON BLVD, SUITE 260Pasadena, CA 91107-1448

Mailing Address2750 E Washington Blvd, Suite 260Pasadena, CA 91107-1448 · (626) 798-8923 · Fax (626) 798-0258

Phone(626) 798-8923

Fax(626) 798-0258

Organization SubpartNo

Authorized OfficialCindy ChonAdministrator · (626) 798-8923

Enumeration DateMay 1, 2007

Last NPPES UpdateJanuary 28, 2011

✔ NPI 1053532580 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in CA · A42891

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

2750 E WASHINGTON BLVD, Pasadena, CA 91107

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Other Identifiers 4

Medicare ID-Type UnspecifiedW13909CA

Medicare UPINC04014CA

MedicaidGR0076360CA

Medicare PINW13909ACA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jason K Boutros M D Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateCaliforniaEnrollment IDO20031201000293Non-DME Part B · Clinic/Group PracticeDue dateDecember 31, 2026

Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Jason K Boutros M D Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jason Boutros, M.D.

Internal Medicine

NPI 1942243563

2554 E WASHINGTON BLVD STE A
Pasadena, CA 91107

(626) 798-8923

✔ PECOS✔ Accepts Medicare0.2 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0906600

Jason Boutros, MD Inc · Pasadena, CA

Active · expires Oct 2, 2027

CLIA Number05D0906600

Laboratory TypePhysician Office

Certificate Effective DateOctober 3, 2025

Certificate Expiration DateOctober 2, 2027

Laboratory DirectorJason Boutros

Laboratory Phone(626) 798-8923

Laboratory LocationJason Boutros, MD Inc2554 E Washington Blvd Ste A, Pasadena, CA 91107

CLIA data matches this NPI record on: Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jason K Boutros M D Inc's NPI number?

The NPI number for Jason K Boutros M D Inc is 1053532580. It was assigned to this organization in the NPPES registry on May 1, 2007.

Where is Jason K Boutros M D Inc located?

Jason K Boutros M D Inc is located at 2750 E Washington Blvd Suite 260, Pasadena, CA 91107. The listed phone number is (626) 798-8923.

What is Jason K Boutros M D Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Jason K Boutros M D Inc enrolled in Medicare?

Yes. Jason K Boutros M D Inc is registered in the Medicare PECOS enrollment system.

When is Jason K Boutros M D Inc's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Jason K Boutros M D Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Jason K Boutros M D Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Jason K Boutros M D Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0906600) is associated with this NPI, valid through October 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jason K Boutros M D Inc was last updated on January 28, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.