Brian Joseph Bourdeau, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT21211 Issued in FL

Practice address

3651 Cortez Rd W
Ste 100
Bradenton, FL 34210-3167

Phone

(941) 739-7828

Fax

(941) 739-7838

NPI assigned

Oct 13, 2005

Last updated

Feb 16, 2012By 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Maryland School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ortho Florida LLCGroup PAC ID 3274616453, 121 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

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.

• Ortho Florida, LLC

  • Specialist
  • Boca Raton, FL
  • NPI 1821113192
  Medicare reassignment Care Compare group NPD
• Sarasota Orthopedic Associates LLC

  dba 360 Orthopedics

  • Orthopaedic Surgery Physician
  • Nokomis, FL
  • NPI 1013976422
  Medicare reassignment
• Ortho Florida, LLC

  dba Wells Orthopedic Surgery & Sports Medicine

  • Orthopaedic Surgery Physician
  • Fort Lauderdale, FL
  • NPI 1225833858
  NPD

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1336138288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3651 CORTEZ RD W",
            "address_2": "STE 100",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342103167",
            "telephone_number": "941-739-7828",
            "fax_number": "941-739-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3651 CORTEZ RD W",
            "address_2": "STE 100",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342103167",
            "telephone_number": "941-739-7828",
            "fax_number": "941-739-7838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDEAU",
        "first_name": "BRIAN",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT21211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER",
            "identifier": "2288818",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER",
            "identifier": "Y909J",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amir Mohamed Boubekri, MD
• Kyle Boudreaux
• Melissa Beth Boudreaux, PA-C
• Leena Bouhamid, DO
• Donald Boulanger, OTR/L
• Mina Nashaat Boutros, MD
• Shatanya Renee Bowen
• Kathryn Bower, D.O.
• Bowes Imaging Center LLC.
• Kent D Bown, PA

• Physical Therapist in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.