JESSE ALLAN BOUTWELL PHYSICIAN ASSISTANT
NPI 1912977117
Physician Assistant - Medical in Bandera, TX

Active since January 23, 2006PECOS EnrolledAccepts Medicare Assignment
1050 STATE HIGHWAY 16 S, BANDERA, TX 78003(830) 261-0684 Get Directions Write a Review

NPPES record last updated: October 17, 2016. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Jesse Allan Boutwell Physician Assistant NPPES

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

JESSE ALLAN BOUTWELL PHYSICIAN ASSISTANT (NPI 1912977117) is an individual medical provider in Bandera, Texas, licensed in Texas (PA00055) and active in the NPI registry since January 2006. He is enrolled in Medicare PECOS and is a graduate of Other (2006).

NPPES Registry Identity

NPI1912977117
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameJESSE ALLAN BOUTWELLCredential: PHYSICIAN ASSISTANT
Location Address1050 STATE HIGHWAY 16 SBandera, TX 78003-4830
Mailing Address1050 State Highway 16 SBandera, TX 78003-4830 · (830) 261-0684
Sole ProprietorNo
Medical School CMSOtherGraduated 2006
Enumeration DateJanuary 23, 2006
Last NPPES UpdateOctober 17, 2016
NPI 1912977117 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License Licensed in TX · PA00055
1050 STATE HIGHWAY 16 S, Bandera, TX 78003

Other Identifiers 2

Medicare UPINR59579
OtherZ142263Ptan

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Jesse Allan Boutwell Physician Assistant 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 ID6800708876
PECOS Enrollment IDI20040629001264
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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit, 20-29 minutes 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.
32 services32 patients
New patient office or other outpatient visit, 30-44 minutes 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
22 services22 patients

Other Providers at the Same Location NPPES

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

Nurse Practitioner (Family)
1050 STATE HIGHWAY 16 S
BANDERA, TX 78003

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1912977117, enumerated as an "individual" on January 23, 2006.

The provider is located at 1050 STATE HIGHWAY 16 S BANDERA, TX 78003 and the phone number is (830) 261-0684.

Physician Assistant with taxonomy code 363AM0700X and a focus in Medical.

The provider might be accepting Accepts: Ambetter from Arizona Complete Health, Ambetter. Please consult your insurance carrier or call the provider to verify.