LOGAN TYLER BOUTWELL MD
NPI 1649029729
Student in an Organized Health Care Education/Training Program in Gulfport, MS

Q: What is Logan Boutwell's NPI number?

The NPI number for Logan Boutwell is 1649029729. It was assigned to this individual provider in the NPPES registry on May 13, 2024.

Q: What is Logan Boutwell's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Logan Boutwell was last updated on May 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since May 13, 2024PECOS Enrolled

4500 13TH ST, GULFPORT, MS 39501(228) 867-4000 Get Directions Write a Review

NPPES record last updated: May 13, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Logan Tyler Boutwell Md NPPES

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

LOGAN TYLER BOUTWELL MD (NPI 1649029729) is an individual student in an organized health care education/training program in Gulfport, Mississippi and active in the NPI registry since May 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1649029729

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameLOGAN TYLER BOUTWELLCredential: MD

Location Address4500 13TH STGulfport, MS 39501-2515

Mailing Address995 Bay Shore DrBiloxi, MS 39530-1751 · (601) 270-3388

Phone(228) 867-4000

Sole ProprietorNo

Enumeration DateMay 13, 2024

NPPES CertifiedMay 6, 2024

✔ NPI 1649029729 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

4500 13TH ST, Gulfport, MS 39501

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Logan Tyler Boutwell Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

HEATHER LYN JEFFREY

Nurse Practitioner