Charles Bourne

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

SP021873 Issued in PA

Practice address

5528 Morris St
Philadelphia, PA 19144-3807

Phone

(267) 243-9206

NPI assigned

Jan 29, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Nurse Practitioner

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.

• Matrix Medical Plus

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1376973461

  PA

  Medicare reassignment NPD

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

{
    "created_epoch": "1611878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611878400000",
    "number": "1326639642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5528 MORRIS ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191443807",
            "telephone_number": "267-243-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5528 MORRIS ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191443807",
            "telephone_number": "267-243-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNE",
        "first_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-29",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "SP021873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamar Bourdeau
• Karim Michael Bourenane, MD
• Brianna Bourgeois, MD, PHD
• Danielle Abbey Bourgeon, MS, LPC, NCC, CRC
• Daniele Michelle Bourget, MD
• Hope Hyshante Bourne
• Marquis Everett Bourne
• McKenzie Bourque
• Murielle M Boursiquot, MA
• Katharine Bouser, MS, CCC-SLP

• Gerontology Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Gerontology Nurse Practitioner in Pennsylvania

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