DR. MICHAEL S BOUTON (NPI# 1356336358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356336358 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL S BOUTON |
| Credential | MD |
| Practice Address |
801 Broadway N Fargo ND 58102-3641 |
| Mailing Address |
Po Box 2010 Fargo ND 58122-0605 |
| Practice Telephone | 7012342251 |
| Practice Fax Number | 7012342050 |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2012-01-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 10920 | ND | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | G9329 | TX | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | R4107 | AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 14800 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639490295 | Michael K Bouton | Emergency Medicine | 506 Lenox Ave, New York, NY 10037-1802 | 2010-06-17 |
| Street Address |
801 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-3641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528062924 | Mark F Fisher | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2005-06-13 |
| 1942809652 | Morgan Margaret Borud | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-10-22 |
| 1790392462 | Katie Thielges | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-09-28 |
| 1063022432 | Lindsey Schmidt | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-07-31 |
| 1336766161 | Yesha Shukla | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-27 |
| 1891310850 | Samantha Mimi Chang | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-15 |
| 1528683224 | Briana Lee Gebert-oberle | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-09 |
| 1689296931 | Jillian Virginia Schommer | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-05-09 |
| 1194344036 | Sarah Rose Carpenter | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-04-10 |
| 1346871258 | Randall Hagemeister | Nurse Anesthetist, Certified Registered | 801 Broadway N, Fargo, ND 58102-3641 | 2020-01-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811131527 | Daphne Watkins Denham | Surgery | 4487 Calico Dr S Unit B, Fargo, ND 58104-9040 | 2009-04-24 |
| 1689608192 | Timothy J Mahoney | Surgery | 1707 Gold Dr S Ste 101, Fargo, ND 58103-6413 | 2006-07-10 |
| 1023040219 | Jerome I Thompson | Surgery | 737 Broadway N, Fargo, ND 58122-0001 | 2006-07-07 |
| 1972097756 | Jackson Rucker Staggers | Surgery | 5225 23rd Ave S, Fargo, ND 58104 | 2018-06-15 |
| 1013295260 | Zachary Joseph Ernst | Surgery | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2011-07-21 |
| 1457650632 | Megan Bowen | Surgery | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2011-03-27 |
| 1487972972 | Sugong Chen | Surgery | 1717 University Dr S, Fargo, ND 58103-4939 | 2010-05-10 |
| 1720217425 | Kayla Jo Burchill | Surgery | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2009-07-02 |
| 1225264104 | Jeena Easow | Surgery | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2009-06-05 |
| 1851553325 | Jay Martin Macgregor | Surgery | 801 Broadway N, Fargo, ND 58102-3641 | 2008-06-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.