Paul G Bouressa, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD20093 Issued in OR

Practice address

3377 Riverbend Dr
Springfield, OR 97477-8800

Phone

(541) 222-6400

NPI assigned

Feb 6, 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 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Peacehealth

  • Multi-Specialty Clinic/Center
  • Florence, OR
  • NPI 1982774378
  Medicare reassignment NPD
• Peacehealth Medical Group

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1447207287

  Pediatrics

  Medicare reassignment NPD
• Peacehealth

  • General Acute Care Hospital
  • Springfield, OR
  • NPI 1083888515
  NPD (past)

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228089600000",
    "number": "1366414047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24410",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974020451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3377 RIVERBEND DR",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "541-222-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURESSA",
        "first_name": "PAUL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2008-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD20093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P370012349",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "082417",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lizbeth Borchardt, CRNA
• Dean Born
• Doris Lynn Boshaw, RN, MSN, CNOR
• Michelle Queneau Bosworth, MS
• Jennifer Bourassa, QMHP
• Ann Pauline Bowers, MD
• Donald Bowman, CRNA
• Jeannine Bowman, LMT
• Emma Boyer, MS
• Anna Elizabeth Braddock, PA-C

• Pediatrics Physician in Springfield, OR
• Providers in Springfield, OR by specialty
• Pediatrics Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; 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.