Kristin Bourg, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

RN008722 Issued in GA

Practice address

1968 Peachtree Rd NW
Atlanta, GA 30309

Phone

(404) 605-2800

NPI assigned

Jan 25, 2018

Last updated

Nov 13, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Alabama School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Truffles Vein Center LLCGroup PAC ID 1355594797, 14 clinicians

Truffles Vein of Central Georgia LLCGroup PAC ID 8527594662, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Truffles Vein of Central Georgia LLC

  • Vascular Specialist/Technologist Cardiovascular
  • Powder Springs, GA
  • NPI 1457100430
  Medicare reassignment Care Compare group NPD
• Truffles Vein Center, LLC

  • Plastic Surgery Physician
  • Fayetteville, GA
  • NPI 1760733448
  Medicare reassignment Care Compare group
• Georgia Phlebology PC

  • Surgery Physician
  • Alpharetta, GA
  • NPI 1598701450
  Medicare reassignment
• Renew Wound Care of Georgia LLC

  • Internal Medicine Physician
  • Columbus, GA
  • NPI 1245907971
  NPD

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

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542067200000",
    "number": "1619475530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BUTTERFIELD RD STE 300",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151069",
            "telephone_number": "630-725-2730",
            "fax_number": "844-205-5691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 PEACHTREE RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30309",
            "telephone_number": "404-605-2800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "264 19th St NW Ste 2240",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303631139",
            "country_code": "US",
            "telephone_number": "404-532-1564",
            "fax_number": "404-532-1565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURG",
        "first_name": "KRISTIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-25",
        "last_updated": "2018-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "RN008722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary F Bouloux, MD, DDS
• Jennica Phenide Bouquet
• Viktor Bouquette, M.D.
• Andrei Petrovich Bourdeinyi, D.C.
• Denise Dorothy Bourg, PT
• Debra Bourgeois, CCC-SLP
• Caitlin Adrianna Bourland, APC
• Camryn Vega Bourne
• Cheryl Andrea Jackson Bourne
• Ebon Anthony Bourne, M.D.

• Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2018; 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.