Marissa Bournique

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

OS15441 Issued in FL

Practice address

1700 SE Hillmoor Dr
Port St Lucie, FL 34952-7539

Phone

(772) 335-9600

NPI assigned

Jul 23, 2015

Last updated

Apr 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, SC3 enrollments

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 3

Specialty

Gastroenterology

Education

Lake Erie College of Osteopathic Medicine, Bradenton, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tallahassee Memorial Healthcare IncGroup PAC ID 6103724778, 498 clinicians

Lee Health System IncGroup PAC ID 9335672146, 1,381 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Gulf Coast Medical Center Lee Health Hospital, Fort Myers, FL, CCN 100220
• Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012
• Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135
• Bethesda Hospital East Hospital, Boynton Beach, FL, CCN 100002

Merit-based Incentive Payment System (MIPS)

Final score

94.7 of 100Reported as apm

Quality

89.4

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: mbournique78069@direct.anmedhealth.net

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.

• Lee Health System Inc

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1942058557
  Medicare reassignment Care Compare group NPD
• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  Medicare reassignment Care Compare group
• Anmed Health

  dba AnMed Health Westside Family Medicine

  • Family Medicine Physician
  • Anderson, SC
  • NPI 1639102270
  Medicare reassignment NPD
• Lee Health System Inc

  dba Lee Health Specialty Pharmacy

  • Community/Retail Pharmacy
  • Bonita Springs, FL
  • NPI 1699510925
  NPD
• Anmed Health

  dba AnMed Primary Care - Piedmont

  • Family Medicine Physician
  • Piedmont, SC
  • NPI 1255137832
  NPD
• Anmed Health

  dba AnMed Gastroenterology

  • Gastroenterology Physician
  • Anderson, SC
  • NPI 1861761090
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bethesda Hospital, Inc.

  • General Acute Care Hospital
  • Boynton Beach, FL
  • NPI 1417952748
  Care Compare affiliation
• Lee Health System Inc

  dba Gulf Coast Medical Center

  • General Acute Care Hospital
  • Fort Myers, FL
  • NPI 1366281750
  Care Compare affiliation
• Lee Health System Inc

  dba Lee Memorial Hospital

  • General Acute Care Hospital
  • Fort Myers, FL
  • NPI 1427806025
  Care Compare affiliation
• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  Care Compare affiliation

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1417332131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 SE HILLMOOR DR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527539",
            "telephone_number": "772-335-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 SE HILLMOOR DR",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527539",
            "telephone_number": "772-335-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURNIQUE",
        "first_name": "MARISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-23",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "UO4447",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "OS15441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Gastroenterology Physician in Florida

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