NPIMap

Individual provider Active NPI

Brandon Elliott Bourgeous, MD

  • Obstetrics & Gynecology Physician
  • Cedar Rapids, IA
National Provider Identifier
1669476602
Registry record updated Dec 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
34399 Issued in IA
Practice address
788 8TH Ave SE
Suite 100
Cedar Rapids, IA 52401-2107
Phone
(319) 363-2682
Fax
(319) 363-1473
NPI assigned
Jun 8, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 34399 IA Primary

Addresses

Primary practice location

788 8TH Ave SE
Suite 100
Cedar Rapids, IA 52401-2107

Mailing address

788 8TH Ave SE
Suite 100
Cedar Rapids, IA 52401-2107
Phone (319) 363-2682

Other identifiers 1

IdentifierTypeStateIssuer
0254680MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100515000084 IA Practitioner - Obstetrics/Gynecology 4789648676 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Iowa, RJ & L Carver College of Medicine, 1998
Medicare assignment
May accept Medicare assignment
Group practices
Crescent Community Health Center 17 clinicians
Cedar Rapids OB-GYN Specialists, P.C. 8 clinicians

Practice addresses (Care Compare)

1690 Elm St
Dubuque, IA 52001-3679
Phone (563) 690-2850

788 8TH Ave SE
Suite 100
Cedar Rapids, IA 52401-2106
Phone (319) 363-2682

Hospital & facility affiliations

  • Mercy Medical Center - Cedar Rapids Hospital, Cedar Rapids, IA, CCN 160079
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34399IAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Waverly Health Center CurrentSince Jan 1, 2026 Accepting new patients
Waverly Health Center Obstetrics & Gynecology CurrentSince Jan 7, 2026 Accepting new patients
Waverly Health Center CurrentSince Jan 1, 2026 Accepting new patients
Cedar Rapids OB-GYN Specialists, P.C. Obstetrics & Gynecology CurrentSince May 15, 2010 Accepting new patients
Crescent Community Health Center Past Accepting new patients
St Luke'S Methodist Hospital Past Accepting new patients
Mercy Medical Center Past Accepting new patients

Locations

788 8th Ave SE
Ste 100
Cedar Rapids, IA 52401
Phone (319) 363-2682

312 9th St SW
Waverly, IA 50677
Phone (319) 352-4120

Interoperability endpoints

  • Direct secure messaging: brandon.bourgeous.1@20991.direct.athenahealth.com
  • Direct secure messaging: bbourgeous651171@direct.ochin.org
  • FHIR API: https://api.platform.athenahealth.com/20991/brand/1/csg/1/fhir/r4

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324944000000",
    "number": "1669476602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 8TH AVE SE",
            "address_2": "SUITE 100",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524012107",
            "telephone_number": "319-363-2682",
            "fax_number": "319-363-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "788 8TH AVE SE",
            "address_2": "SUITE 100",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524012107",
            "telephone_number": "319-363-2682",
            "fax_number": "319-363-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGEOUS",
        "first_name": "BRANDON",
        "middle_name": "ELLIOTT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2011-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IA",
            "license": "34399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0254680",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

Verify at the official NPI Registry.