DR. NIDAL BOUTROS
NPI 1629036173
Internal Medicine in Lebanon, MO
About Dr. Nidal Boutros NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. NIDAL BOUTROS (NPI 1629036173) is an individual internal medicine provider in Lebanon, Missouri, licensed in Missouri (2009027847) and active in the NPI registry since May 2006. He is enrolled in Medicare PECOS, is affiliated with University Of Kansas Hospital, and is a graduate of Other (1990).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted 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. Nidal Boutros 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.
Medicare Billing Reassignment
Medicare enrollment records show Nidal Boutros reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Overland Park, KS 66209
- Reassigned Medicare billing, Kansas enrollment
- 5 clinicians in this Medicare group
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 12
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.
Hospital Affiliations CMS Care Compare 5
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
University Of Kansas Hospital
Acute Care Hospitals · Kansas City, KSOverland Park Reg Med Ctr
Acute Care Hospitals · Overland Park, KSMenorah Medical Center
Acute Care Hospitals · Overland Park, KSSaint Luke's South Hospital
Acute Care Hospitals · Overland Park, KSBelton Regional Medical Center
Acute Care Hospitals · Belton, MOPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 65536 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims 3
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LEBANON, MO 65536
LEBANON, MO 65536
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 Nidal Boutros's NPI number?
The NPI number for Nidal Boutros is 1629036173. It was assigned to this individual provider in the NPPES registry on May 3, 2006.
Where is Nidal Boutros located?
Nidal Boutros practices at 120 Hospital Dr Suite 300, Lebanon, MO 65536. The listed phone number is (417) 533-6746.
What is Nidal Boutros's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Nidal Boutros enrolled in Medicare?
Yes. Nidal Boutros is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Nidal Boutros's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Nidal Boutros reassigns Medicare benefits to Statland Medical Group LLC (Overland Park, KS). The 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 Nidal Boutros's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Nidal Boutros accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Ambetter of Oklahoma and Anthem Blue Cross and Blue Shield and 2 other insurers list Nidal Boutros as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Nidal Boutros affiliated with any hospitals?
According to CMS data, Nidal Boutros is affiliated with University Of Kansas Hospital, Overland Park Reg Med Ctr, Menorah Medical Center, Saint Luke's South Hospital and Belton Regional Medical Center.
When was this NPI record last updated?
The NPPES record for Nidal Boutros was last updated on February 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Dr. Nidal Boutros · NPI 1629036173
Internal Medicine physician in Lebanon, Missouri. Individual provider, active in the CMS NPPES registry since May 3, 2006.
## Identity
- **NPI:** 1629036173 (Entity type: Individual)
- **Enumerated:** May 3, 2006
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **State license:** 2009027847 (Missouri)
- **Sole proprietor:** No
## Practice location
- **Address:** 120 HOSPITAL DR, SUITE 300, Lebanon, MO 65536-9238
- **Phone:** (417) 533-6746 · **Fax:** (417) 533-6740
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Statland Medical Group LLC (NPI 1902123573, Overland Park, KS), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 1990
## Record status
- **NPPES last updated:** February 10, 2022
- **Other identifiers:** Medicaid 1629036173 (MO)
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Source: [NPI Profile](https://npiprofile.com/npi/1629036173) · Data from the CMS NPPES public registry.