MR. JUSTIN BOUTWELL (PA) – Medical Physician Assistant, NPI 1861959017
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for MR. JUSTIN BOUTWELL (PA)
Jennie M. Melham Memorial Medical Center, 145, Memorial Drive, Broken Bow, Custer County, Nebraska, 68822, United States
BROKEN BOW, NE 688221378
Phone: (308) 872-2486
Fax: (308) 872-2027
Type: Location
1316 Logan St
Holdrege, NE 689491448
Phone: (308) 991-4571
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $16.
Total Amount is formed as General ($16) + Research ($0) + Ownership ($0) = $16.
Last reported payment date: 2023-07-18 • Largest payer in this snapshot: SANOFI PASTEUR INC. ($16).
Total Amount
$16
General + Research + Ownership
Payments
1
Total payment records
General Amount
$16
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-07-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| SANOFI PASTEUR INC. | $16 |
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: 2019-08-27
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 |
|---|---|---|---|---|
| I20190827004075 | I | Physician Assistant | NE | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 117 | 90 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 63 | 48 | $0 |
| 85025 | Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count | 47 | 40 | $0 |
| 80053 | Blood test, comprehensive group of blood chemicals | 42 | 35 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 36 | 24 | $0 |
Insurance plans in this area (ZIP 68822)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | NE | |
| Physician Assistant | NE | |
| Nurse Practitioner | NE | |
| Physician Assistant | NE | |
| Family Practice | IA |
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