Jeffrey Philip Bourne, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G86941 Issued in CA

Practice address

12555 W Jefferson Blvd Ste 302
Los Angeles, CA 90066-7032

Phone

(424) 443-5600

Fax

(424) 443-5600

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jbourne463977@oc.providencedirect.org
• Direct secure messaging: jbourne12986@direct.uclahealth.org

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.

• Providence Saint Johns Medical Foundation

  • Specialist
  • Santa Monica, CA
  • NPI 1770093734

  Pediatrics

  Medicare reassignment NPD

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1164569091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 WILSHIRE BLVD STE 110",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035626",
            "telephone_number": "310-453-9010",
            "fax_number": "310-828-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 W JEFFERSON BLVD STE 302",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900667032",
            "telephone_number": "424-443-5600",
            "fax_number": "424-443-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1811 Wilshire Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Santa Monica",
            "state": "CA",
            "postal_code": "904035626",
            "country_code": "US",
            "telephone_number": "310-453-9010",
            "fax_number": "310-828-3661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "JEFFREY",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME66931",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G86941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jbourne463977@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12555 W Jefferson Blvd Ste 302",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900667032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gabriel Bourdeau
• Jillian Bourdon
• Linda Marie Bourell, OTR-L
• Maria Cristina Bouri
• Daniel David Bourke, CRNA
• Kanita Danielle Bourne, LCSW
• Erin Savanna Bouska, MD
• Jose Luis Bouso, DC
• Chayma Boussayoud, MD
• Tal Boussi

• Pediatrics Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.