NPIMap

Individual provider Active NPI

Bruce P. Bordlee, M.D.

  • Diagnostic Radiology Physician
  • Lake Charles, LA
National Provider Identifier
1609859594
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
016057 Issued in LA
Practice address
1800 Ryan St
Suite 105
Lake Charles, LA 70601-6078
Phone
(337) 439-4706
Fax
(337) 439-8110
NPI assigned
Nov 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 016057 LA Primary

Addresses

Primary practice location

1800 Ryan St
Suite 105
Lake Charles, LA 70601-6078

Mailing address

1800 Ryan St
Suite 105
Lake Charles, LA 70601-6078
Phone (337) 439-4706

Other identifiers 3

IdentifierTypeStateIssuer
1349798MedicaidLA
16570OtherLACDS
300036309OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
016057LAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health LLP Past Accepting new patients
Second Avenue MRI LLC Diagnostic Radiology PastSince Jul 19, 2014 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1609859594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 RYAN ST",
            "address_2": "SUITE 105",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706016078",
            "telephone_number": "337-439-4706",
            "fax_number": "337-439-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 RYAN ST",
            "address_2": "SUITE 105",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706016078",
            "telephone_number": "337-439-4706",
            "fax_number": "337-439-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDLEE",
        "first_name": "BRUCE",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "016057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1349798",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS",
            "identifier": "16570",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300036309",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.