Albert Bourbon

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

92PA08 Issued in NU

Practice address

301 Unser Blvd NW
Albuquerque, NM 87121-1927

Phone

(505) 925-4126

Fax

(505) 925-4721

NPI assigned

Oct 18, 2006

Last updated

Jun 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Unm Hospital

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1689747552

  Physician Assistant

  Medicare reassignment NPD
• Unm Hospital

  • Air Ambulance
  • Albuquerque, NM
  • NPI 1558054684
  NPD
• Las Vegas Stat Care Inc.

  • General Practice Physician
  • Las Vegas, NM
  • NPI 1730194499
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1194806638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 BRADBURY DR SE",
            "address_2": "SUITE 2222",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064374",
            "telephone_number": "505-272-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 UNSER BLVD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871211927",
            "telephone_number": "505-925-4126",
            "fax_number": "505-925-4721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURBON",
        "first_name": "ALBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": "92PA08",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMH@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "2211 Lomas Blvd NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871062719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Felicia Boulier
• Emmanuel P Boulogne, DC
• Adriana Suzanne Boulton, PMHNP-BC
• Nikole Bouma
• Bounce Back Counseling, LLC
• Genevieve Bourgeois, CNP-BC
• Jane Lynn Bourgeois, RN
• Ryan Bourgoine
• Madison Bourgois
• Earl Douglas Bourgoyne, BSCPO

• Physician Assistant in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.