DR. LON A BOUTIETTE (MD) – Emergency Medicine Physician, NPI 1174574479
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. LON A BOUTIETTE (MD)
PO BOX 88452
CHICAGO, IL 606801452
Phone: (205) 437-6098
Fax: (205) 437-5998
Type: Mailing
Fort Walton Beach Medical Center, 1000, Mar Walt Drive, Wright, Fort Walton Beach, Okaloosa County, Florida, 32547, United States
FORT WALTON BEACH, FL 325476708
Phone: (850) 863-7607
Fax: (205) 437-5998
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-05-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040514000434 | I | Emergency Medicine | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99284 | Emergency department visit with moderate level of medical decision making | 128 | 116 | $0 |
| 99285 | Emergency department visit with high level of medical decision making | 28 | 28 | $0 |
| 99283 | Emergency department visit with low level of medical decision making | 11 | 11 | $0 |
Insurance plans in this area (ZIP 60680)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| - | FL | |
| - | KS |
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