Jonathan Bourne, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G48548 Issued in CA

Practice address

85 Sierra Park Rd
Mammoth Lakes, CA 93546-0660

Phone

(760) 924-4078

Fax

(760) 924-4058

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Mono Health Care District

  • Critical Access Hospital Clinic/Center
  • Mammoth Lakes, CA
  • NPI 1962444059
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279843200000",
    "number": "1013062660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "address_2": "85 SIERRA PARK RD",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460660",
            "telephone_number": "760-924-4078",
            "fax_number": "760-924-4058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SIERRA PARK RD",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460660",
            "telephone_number": "760-924-4078",
            "fax_number": "760-924-4058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2010-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G48548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Bathen Bissell, M.D.
• Shanna Lynn Bissonette, D.C.
• Richard Charles Bonneau
• Karen Bottom, CNM
• Eric Bourne, M.D.
• Lucienne Simone Bouvier, MD
• Sandra Bowman, CNOR, RNFA
• Laura Suzanne Brown
• Bryan S. Dennison
• Dylan Scott Burditt, LCSW

• Anesthesiology Physician in Mammoth Lakes, CA
• Providers in Mammoth Lakes, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.