NPIMap

Individual provider Active NPI

Kevin Patrick Bordeau, MD

  • Specialist
  • Pittsburgh, PA
National Provider Identifier
1164421509
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD425640 Issued in PA
Practice address
1145 Bower Hill Rd
Pittsburgh, PA 15243-1342
Phone
(412) 572-6194
Fax
(412) 572-6195
NPI assigned
Jul 19, 2005
Last updated
Mar 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD425640 PA Primary

Addresses

Primary practice location

1145 Bower Hill Rd
Pittsburgh, PA 15243-1342

Mailing address

1000 Bower Hill Road
Attn Pamalyn Affiliate Billing
Pittsburgh, PA 15243-1873
Phone (412) 942-2548

Other identifiers 2

IdentifierTypeStateIssuer
1545957OtherPAGATEWAY
P00230561OtherPAPALMETTO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Pamalyn.Patnesky@stclair.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050523000709 PA Practitioner - Urology 1850333675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Tufts University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Clair Medical Services IncGroup PAC ID 4183511553, 203 clinicians

Practice addresses (Care Compare)

1145 Bower Hill Rd
Suite 105
Pittsburgh, PA 15243-1346
Phone (712) 579-6194

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection31

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD425640PAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair Medical Services, Inc CurrentSince Mar 1, 2011 Accepting new patients
St Clair Medical Services, Inc. Current Accepting new patients
St Clair Medical Services Inc CurrentSince Mar 1, 2011 Accepting new patients
St Clair Medical Services Inc Past Accepting new patients
St Clair Medical Services, Inc. PastSince Oct 5, 2021 Accepting new patients

Locations

1000 Bower Hill Rd
Pittsburgh, PA 15243
Phone (412) 344-6600

1000 Bower Hill Rd
Ste 7600
Pittsburgh, PA 15243
Phone (412) 942-4100

1145 Bower Hill Rd
Ste 105
Pittsburgh, PA 15243
Phone (412) 572-6194

Interoperability endpoints

  • Direct secure messaging: kbordeau642889@direct.wvuhsdirect.com

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, 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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1164421509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BOWER HILL ROAD",
            "address_2": "ATTN PAMALYN AFFILIATE BILLING",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152431873",
            "telephone_number": "412-942-2548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 BOWER HILL RD",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152431342",
            "telephone_number": "412-572-6194",
            "fax_number": "412-572-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEAU",
        "first_name": "KEVIN",
        "middle_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2021-03-09",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD425640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY",
            "identifier": "1545957",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "P00230561",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Pamalyn.Patnesky@stclair.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Pamalyn.Patnesky@stclair.org",
            "address_1": "1145 Bower Hill Rd",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152431342",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.