NPIMap

Individual provider Active NPI

Michael Ray Bourne, MD

  • Podiatrist
  • Stillwater, MN
National Provider Identifier
1164412649
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
445 Issued in MN
Practice address
1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Phone
(651) 439-1234
Fax
(651) 275-3325
NPI assigned
Oct 25, 2005
Last updated
Apr 23, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 746 WI
Podiatrist 213E00000X 746 WI
Podiatrist 213E00000X 445 MN Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 445 MN

Addresses

Primary practice location

1500 Curve Crest Blvd W
Stillwater, MN 55082-6040

Mailing address

8170 33Rd Ave S # Ms 21110Q
Minneapolis, MN 55425-4516

Other identifiers 2

IdentifierTypeStateIssuer
164225100MedicaidMN
43222300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050328000193 MN Practitioner - Podiatry 1951357540 Reassigns benefits to 2 organizations
I20050404000927 WI Practitioner - Podiatry 1951357540 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians
Amery Regional Medical Center IncGroup PAC ID 2769391960, 124 clinicians

Practice addresses (Care Compare)

1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Phone (952) 831-8742

265 Griffin E St
Amery, WI 54001-1439
Phone (715) 268-8000

265 Griffin St E
Amery, WI 54001-1439
Phone (715) 268-8000

403 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

405 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

411 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue14
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
445MNMDProfessional Counselor
746WIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Amery Regional Medical Center, Inc. CurrentSince Jan 10, 2023 Accepting new patients
Group Health, Inc. CurrentSince Jan 1, 2016 Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Dec 25, 2025 Accepting new patients
Westfields Hospital, Inc CurrentSince Dec 8, 2022 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Jun 9, 2020 Accepting new patients
Group Health, Inc. Current Accepting new patients
Amery Regional Medical Center, Inc. CurrentSince Jan 10, 2023 Accepting new patients
Westfields Hospital, Inc. CurrentSince Dec 8, 2022 Accepting new patients
Group Health, Inc. CurrentSince Jan 1, 2016 Accepting new patients
Group Health, Inc. Past Accepting new patients
Amery Regional Medical Center, Inc. Past Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

700 Wildwood Rd
Saint Paul, MN 55115
Phone (651) 351-6151

1500 Curve Crest Blvd W
Stillwater, MN 55082

921 Greeley St S
Stillwater, MN 55082

265 Griffin St E
Amery, WI 54001
Phone (715) 268-0301

405 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000

411 Stageline Rd
#200
Hudson, WI 54016
Phone (715) 531-6700

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

700 Rivard St
Somerset, WI 54025
Phone (715) 247-2060

744 E Louisiana St
St Croix Fls, WI 54024
Phone (651) 772-6251

Interoperability endpoints

  • Direct secure messaging: mbourne20778@direct.healthpartners.com

Organizations & group practices 12

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

Hospital & facility affiliations 8

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": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776902400000",
    "number": "1164412649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CURVE CREST BLVD W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826040",
            "telephone_number": "651-439-1234",
            "fax_number": "651-275-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "MICHAEL",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WI",
            "license": "746",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "WI",
            "license": "746",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "445",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MN",
            "license": "445",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164225100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43222300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

Verify at the official NPI Registry.