DR. DOMINIQUE M BUTAWAN-ALI MD
NPI 1417121013
Obstetrics & Gynecology in Memphis, TN

Q: What is Dominique Butawan-ali's NPI number?

The NPI number for Dominique Butawan-ali is 1417121013. It was assigned to this individual provider in the NPPES registry on April 15, 2008. The provider is also known as Dr. Dominique M Butawan M.D..

Q: What is Dominique Butawan-ali's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Active since April 15, 2008PECOS EnrolledAccepts Medicare Assignment

6215 HUMPHREYS BLVD STE 100, MID SOUTH OB-GYN PLLC, MEMPHIS, TN 38120(901) 747-1200(901) 747-1220 Get Directions Write a Review

NPPES record last updated: October 16, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jun 2, 2025, Feb 27, 2025, Nov 19, 2024 and 3 more (6 updates tracked since 2015).

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About Dr. Dominique M Butawan-ali Md NPPES

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

DR. DOMINIQUE M BUTAWAN-ALI MD (NPI 1417121013) is an individual obstetrics & gynecology provider in Memphis, Tennessee, licensed in Tennessee (54889) and active in the NPI registry since April 2008. She is enrolled in Medicare PECOS, is affiliated with Baptist Memorial Hospital Desoto, and is a graduate of University Of Tennessee, Hsc, College Of Medicine (2012).

NPPES Registry Identity

NPI1417121013

Entity TypeIndividualFemale

Primary Taxonomy207V00000X

Provider Legal NameDR. DOMINIQUE M BUTAWAN-ALICredential: MD

Location Address6215 HUMPHREYS BLVD STE 100, MID SOUTH OB-GYN PLLCMemphis, TN 38120

Mailing Address6215 Humphreys Blvd Ste 100Memphis, TN 38120-2382 · (901) 747-1200 · Fax (901) 747-1220

Phone(901) 747-1200

Fax(901) 747-1220

Sole ProprietorNo

Medical School CMSUniversity Of Tennessee, Hsc, College Of MedicineGraduated 2012

Enumeration DateApril 15, 2008

Last NPPES UpdateOctober 16, 20256 updates tracked since enumeration

NPPES CertifiedOctober 16, 2025

✔ NPI 1417121013 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians

Taxonomy Code207V00000X

Licenses✔ Licensed in TN · 54889✔ Licensed in AR · E-8519✔ Licensed in NC · 201200884

Definition

An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

6215 HUMPHREYS BLVD STE 100, Memphis, TN 38120

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Other Names 1

Former Name (1)Dr. Dominique M Butawan M.d.

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Arkansas Blue Cross and Blue Shield, BlueCross BlueShield of Tennessee, Health Advantage and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Dominique M Butawan-ali Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7517123441

PECOS Enrollment IDI20170110000306

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Dominique Butawan-ali reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mid-South Ob-Gyn PLLC

Same address

Obstetrics & Gynecology

6215 HUMPHREYS BLVD STE 100
Memphis, TN 38120

Reassigned Medicare billing, Tennessee enrollment
9 clinicians in this Medicare group

NPI 1952136301 (901) 747-1200

Women's Care Center Of Memphis, Mpllc

Same address

Obstetrics & Gynecology

6215 HUMPHREYS BLVD STE 100
Memphis, TN 38120

Reassigned Medicare billing, Tennessee enrollment
31 clinicians in this Medicare group

NPI 1720151418 (901) 747-1200

Baptist Memorial Medical Group Inc

7.6 mi

Internal Medicine

8970 WINCHESTER RD
Memphis, TN 38125

Reassigned Medicare billing, Tennessee enrollment
581 clinicians in this Medicare group

NPI 1306089206 (901) 227-4068

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

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Urinalysis, manual test 81002

A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.

20 services18 patients

Cervical or vaginal cancer screening; pelvic and clinical breast examination G0101

This procedure involves checking for health issues in the lower abdomen and chest area. It helps identify early signs of certain conditions, increasing the chance for successful treatment. It's a routine check-up that's important for maintaining good health.

16 services16 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

12 services11 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Baptist Memorial Hospital Desoto

Acute Care Hospitals · Southaven, MS

1/5 CMS rating

OwnershipProprietary

CMS Certification Number250141

Location7601 Southcrest ParkwaySouthaven, MS 38671 · De Soto County

Emergency services Birthing friendly

Baptist Memorial Hospital

Acute Care Hospitals · Memphis, TN

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number440048

Location6019 Walnut Grove RoadMemphis, TN 38120 · Shelby County

Emergency services Birthing friendly

Methodist Hospitals Of Memphis

Acute Care Hospitals · Memphis, TN

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number440049

Location1265 Union Ave Suite 700Memphis, TN 38104 · Shelby County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 38120 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$121.80 typical visit price

range $52.64 – $160.89

Typical copayment $30.45 (range $13.16 – $40.22)

Most-billed visit code 99204

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. FAITH CREEKMORE PRICE MD

Obstetrics & Gynecology