Active NPI
Ryan Bourgoine
- Acute Care Nurse Practitioner
- Albuquerque, NM
National Provider Identifier
1215744990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 90733
- Practice address
- 504 Elm St NE
Albuquerque, NM 87102-2512 - Phone
- (505) 841-1000
- NPI assigned
- Dec 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 90733 | NM | Primary |
| Critical Care Medicine Registered Nurse | 163WC0200X | RN80646 | NM |
Addresses
Primary practice location
504 Elm St NE
Albuquerque, NM 87102-2512
Mailing address
504 Elm St NE
Albuquerque, NM 87102-2512
Phone (505) 841-1000
Other practice location 1
45211 Helm St
Plymouth, MI 48170-6023
Phone (734) 525-9712
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN80646 | NM | MD | Critical Care Medicine Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785110400000",
"number": "1215744990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 ELM ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022512",
"telephone_number": "505-841-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 ELM ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022512",
"telephone_number": "505-841-1000"
}
],
"practiceLocations": [
{
"address_1": "45211 Helm St",
"address_purpose": "LOCATION",
"city": "Plymouth",
"state": "MI",
"postal_code": "481706023",
"country_code": "US",
"telephone_number": "734-525-9712",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOURGOINE",
"first_name": "RYAN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-12-16",
"last_updated": "2026-07-27",
"certification_date": "2026-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "NM",
"license": "90733",
"primary": true
},
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "NM",
"license": "RN80646",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2026; 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.