Individual provider Active NPI

Emilie Claire Bourgeois, MD

  • Internal Medicine Physician
  • Bridgeport, CT
National Provider Identifier
1609454966
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
79375 Issued in CT
Practice address
267 Grant St
Bridgeport, CT 06610-2805
Phone
(504) 568-5600
NPI assigned
Mar 30, 2021
Last updated
Oct 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X LA
Internal Medicine Physician 207R00000X 79375 CT Primary

Addresses

Primary practice location

267 Grant St
Bridgeport, CT 06610-2805

Mailing address

2846 Grand Rte Saint John St Apt 1/2
New Orleans, LA 70119-3079
Phone (504) 432-1903

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241025003453 CT Practitioner - Internal MedicinePractitioner - Hospitalist 4082013446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Louisiana State University School of Medicine in New Orleans, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

20 York Street
Suite 329
New Haven, CT 06510-3220

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
86.54
Promoting interoperability
99.98
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Nov 3, 2024 Accepting new patients
Northeast Medical Group Inc CurrentSince Nov 3, 2024 Accepting new patients

Locations

267 Grant St
Bridgeport, CT 06610
Phone (203) 384-3170

300 Seaside Ave
Milford, CT 06460
Phone (203) 876-4000

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Interoperability endpoints

  • Direct secure messaging: ebourgeois692740@direct.ynhh.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1609454966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2846 GRAND RTE SAINT JOHN ST APT 1/2",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701193079",
            "telephone_number": "504-432-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "504-568-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGEOIS",
        "first_name": "EMILIE",
        "middle_name": "CLAIRE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "79375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.