Individual provider Active NPI

Harlie Sue Bourdo-Brown, PA-C

  • Physician Assistant
  • Kirkland, WA
National Provider Identifier
1124631643
Registry record updated Feb 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.61227695 Issued in WA
Practice address
12303 NE 130TH LN Ste 420
Kirkland, WA 98034-3042
Phone
(425) 899-6400
NPI assigned
Aug 25, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.61227695 WA Primary

Addresses

Primary practice location

12303 NE 130TH LN Ste 420
Kirkland, WA 98034-3042

Mailing address

12040 NE 128TH St # Ms -100
Kirkland, WA 98034-3013
Phone (425) 899-1854

Other names 1

  • Harlie Sue Bourdo Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211210001419 WA Practitioner - Physician Assistant 5395135008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
King County Public Hospital District No 2Group PAC ID 7618880097, 586 clinicians

Practice addresses (Care Compare)

12033 NE 130TH LN
Suite 120
Kirkland, WA 98034-3052
Phone (425) 899-2160

12303 NE 130TH LN
Suite 420
Kirkland, WA 98034-3042
Phone (425) 899-6400

Hospital & facility affiliations

  • Evergreenhealth Medical Center Hospital, Kirkland, WA, CCN 500124

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.61227695WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
King County Public Hospital District No. 2 CurrentSince Dec 1, 2021 Accepting new patients
King County Public Hospital District No 2 CurrentSince Dec 1, 2021 Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients
King County Public Hospital District No 2 Past Accepting new patients

Locations

12303 NE 130th Ln
Ste 420
Kirkland, WA 98034
Phone (425) 899-6400

12040 NE 128th St
#100
Kirkland, WA 98034

12040 NE 128th St
#50
Kirkland, WA 98034
Phone (425) 899-1894

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1124631643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12040 NE 128TH ST # MS -100",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343013",
            "telephone_number": "425-899-1854",
            "fax_number": "425-899-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 NE 130TH LN STE 420",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343042",
            "telephone_number": "425-899-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDO-BROWN",
        "first_name": "HARLIE",
        "middle_name": "SUE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-25",
        "last_updated": "2022-02-15",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.61227695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HARLIE",
            "last_name": "BOURDO",
            "middle_name": "SUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.