Active NPI
Jeffery R Bourgerie, O.D.
- Optometrist
- Medford, WI
National Provider Identifier
1164409348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2228
- Practice address
- 309 E Broadway Ave
Medford, WI 54451-1835 - Phone
- (715) 748-2020
- Fax
- (715) 748-4565
- NPI assigned
- Dec 28, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2228 | WI | Primary |
Addresses
Primary practice location
309 E Broadway Ave
Medford, WI 54451-1835
Mailing address
309 E Broadway Ave
P.O. Box 547
Medford, WI 54451-1835
Phone (715) 748-2020
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38715300 | Medicaid | WI | |
| 37815100 | Medicaid | WI | |
| 39-1229699 | Other | WI | FEDERAL TAX ID-MEDFORD |
| 391229699015 | Other | WI | BLUE CROSS BLUE SHIELD-ME |
| 0474980001 | Other | WI | DMERC-MEDFORD GROUP |
| 10445 | Other | WI | NVA-MEDFORD |
| 410045063 | Other | WI | RAILROAD MEDICARE-COLBY |
| 1271670001 | Other | WI | DMERC-COLBY GROUP |
| 21143 | Other | WI | SECURITY HEALTH PLAN-MEDF |
| 2228 | Other | WI | LICENSE NUMBER |
| 39-1967186 | Other | WI | FEDERALTAX ID-COLBY |
| 38581200 | Medicaid | WI | |
| 391967186091 | Other | WI | BLUE CROSS BLUE SHIELD-CO |
| 410015253 | Other | WI | RAILROAD MEDICARE-MEDFORD |
| 63857 | Other | WI | SECURITY HEALTH PLAN-COLB |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2228 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthview Eye Care Center - Chippewa, SC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Chippewa Falls, WI
- NPI 1699871186
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1164409348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 E BROADWAY AVE",
"address_2": "P.O. BOX 547",
"city": "MEDFORD",
"state": "WI",
"postal_code": "544511835",
"telephone_number": "715-748-2020",
"fax_number": "715-748-4565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 E BROADWAY AVE",
"city": "MEDFORD",
"state": "WI",
"postal_code": "544511835",
"telephone_number": "715-748-2020",
"fax_number": "715-748-4565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURGERIE",
"first_name": "JEFFERY",
"middle_name": "R",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-28",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WI",
"license": "2228",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38715300",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "37815100",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID-MEDFORD",
"identifier": "39-1229699",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD-ME",
"identifier": "391229699015",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC-MEDFORD GROUP",
"identifier": "0474980001",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NVA-MEDFORD",
"identifier": "10445",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE-COLBY",
"identifier": "410045063",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC-COLBY GROUP",
"identifier": "1271670001",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECURITY HEALTH PLAN-MEDF",
"identifier": "21143",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "2228",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERALTAX ID-COLBY",
"identifier": "39-1967186",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38581200",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD-CO",
"identifier": "391967186091",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE-MEDFORD",
"identifier": "410015253",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECURITY HEALTH PLAN-COLB",
"identifier": "63857",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.