Michael R Bourbon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149007084 Issued in IL

Practice address

977 Lakeview Pkwy
# 155
Vernon Hills, IL 60061-1400

Phone

(847) 918-0129

Fax

(847) 918-0747

NPI assigned

Nov 22, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• MRB Counseling, SC

  • Clinical Social Worker
  • Vernon Hills, IL
  • NPI 1003981192
  Medicare reassignment NPD Authorized official
• Catherine Corbett LCSW LLC

  • Clinical Social Worker
  • Vernon Hills, IL
  • NPI 1356609721
  NPD

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316012537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "977 LAKEVIEW PKWY",
            "address_2": "# 155",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611400",
            "telephone_number": "847-918-0129",
            "fax_number": "847-918-0747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "977 LAKEVIEW PKWY",
            "address_2": "# 155",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611400",
            "telephone_number": "847-918-0129",
            "fax_number": "847-918-0747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURBON",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149007084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1632567",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gurinder Bolina, PHD
• Richard Neal Bolnick, PSYD
• Bon Vie Therapy LLC
• Susan Bonnem
• Courtney Grayce Bosco, M.S. CFY/SLP
• Christine Marie Bowman, DC
• Sandie Anita Bowman, LCSW
• Kevin Bradley, L.C.S.W., PC
• Alexandra Kohl Brady, MD
• Shari Brady, LPC

• Clinical Social Worker in Vernon Hills, IL
• Providers in Vernon Hills, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.