Irene Mary Bourgault, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

350 Issued in NV

Practice address

3150 N Tenaya Way
660
Las Vegas, NV 89128-0443

Phone

(702) 648-6228

Fax

(702) 648-9868

NPI assigned

Feb 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Family Practice

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Irene M. Bourgault DO PCGroup PAC ID 0446220560, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Irene M. Bourgault DO PC

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1255511739
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352851200000",
    "number": "1164562120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY",
            "address_2": "660",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280443",
            "telephone_number": "702-648-6228",
            "fax_number": "702-648-9868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY",
            "address_2": "660",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280443",
            "telephone_number": "702-648-6228",
            "fax_number": "702-648-9868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGAULT",
        "first_name": "IRENE",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2012-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002002873",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nikkoal Bounds
• Songkeo Bounshedone
• Visouda Bounyavong
• Marie Bounyou
• George Niforos Bouras
• Barbara Bourgeois
• Renee Lillian Bourgeois
• Shelisha Bourgeois
• Amy E Bourji-Nassar, MS-SLP
• Thomas Bourke

• Family Medicine Physician in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.