Irene M. Bourgault DO PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

350 Issued in NV

Legal business name

IRENE M. BOURGAULT DO PC

Practice address

3150 N Tenaya Way Ste 660
Las Vegas, NV 89128-0460

Phone

(702) 648-6228

Fax

(702) 648-9868

NPI assigned

Nov 13, 2007

Last updated

Dec 18, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Irene Mary Bourgault, D.O.NPI 1164562120

Title

Owner

Phone

(702) 648-6228

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Irene Mary Bourgault, D.O.

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1164562120
  Medicare reassignment Care Compare group NPD Authorized official
• Stephanie Carol Casalman, D.O.

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1740364918
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1255511739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 N TENAYA WAY STE 660",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280460",
            "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 STE 660",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280460",
            "telephone_number": "702-648-6228",
            "fax_number": "702-648-9868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRENE M. BOURGAULT DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "BOURGAULT",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-648-6228",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "V32710",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "V32709",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "V39744",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roberto Irawan, OMD
• Joanna Irazu
• Montrell A Irby
• Taylor Ireland
• Irene Lambiris MD PLLC
• Kira Irenze
• Irfan Tahir MD PLLC
• Irfantahirandassociatesinc
• Reyna Iribar
• Mitzu Irigoyen

• 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 Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.