Rebecca Lynn Bourbon, P.A.-C
Individual provider Active NPI Physician Assistant · Rio Rancho, NM
NPI 1003973231 · NPPES record last updated Sep 10, 2015
Key facts
- NPI
- 1003973231
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 92-PA09 (NM)
- Practice address
- 4005 High Resort Blvd SE
Rio Rancho, NM 87124-5906 - Phone
- (505) 462-6000
- Fax
- (505) 462-8472
- NPI assigned
- Jan 3, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.68 of 100
- Quality
- 82.35
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110714000797 | NM | Practitioner - Physician Assistant | 3577731645 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presbyterian Healthcare Services | Current |
Accepting new patients | |
| Presbyterian Healthcare Services | Current |
Accepting new patients | |
| Presbyterian Healthcare Services | Past | Accepting new patients | |
| Zia Internal Medicine Associates, LLC | Past | Accepting new patients |
Locations
2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577
4005 High Resort Blvd SE
Rio Rancho, NM 87124
Phone (505) 462-6000
Interoperability endpoints
- https://drchrono-fhirpresentation.everhealthsoftware.com/fhir/drchrono/504985/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 92-PA09 | NM | Yes |
| Medical Physician Assistant | 363AM0700X | 92-PA09 | NM |
Addresses
Primary practice location
4005 High Resort Blvd SE
Rio Rancho, NM 87124-5906
Mailing address
PO Box 26666
Presbyterian Healthcare Services
Albuquerque, NM 87125-6666
Phone (505) 923-6770
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA920091 | Medicaid | NM |
Other providers in Rio Rancho, NM
- William A Borgeson
- Erin Borrego
- Bosque Clinic LLC
- Bosque Mental Health
- Christopher Bouchard
- Breanne Bower
- David Bowes
- Gary Alan Bowman
- Joelle Lizette Bracken
- Corey Alexander Bradley
All providers in Rio Rancho, NM · Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.