Kaitlin M Bourdeau, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00528000

Practice address

1255 Broad St Ste 201a
Bloomfield, NJ 07003-3061

Phone

(973) 842-2100

NPI assigned

Jul 12, 2019

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 NJ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Balance Medical Care LLC

  • Addiction Medicine (Family Medicine) Physician
  • Saddle Brook, NJ
  • NPI 1053801530
  Medicare reassignment NPD
• Clifton Medical Clinic Inc

  • Internal Medicine Physician
  • Clifton, NJ
  • NPI 1356936611
  Medicare reassignment
• Mehling Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Hackensack, NJ
  • NPI 1659424109
  Medicare reassignment
• Hand & Trauma Institute

  • Surgery of the Hand (Surgery) Physician
  • Cliffside Park, NJ
  • NPI 1053581074
  NPD
• Premier Orthopaedics &Sports Medicine,PC

  • Orthopaedic Surgery Physician
  • Cliffside Park, NJ
  • NPI 1386758423
  NPD
• Passaic Medical Care Inc

  • Family Nurse Practitioner
  • Clifton, NJ
  • NPI 1659749844
  NPD (past)

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

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1780236489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 BRAKESHOE PL",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074301102",
            "telephone_number": "551-804-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 BROAD ST STE 201A",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070033061",
            "telephone_number": "973-842-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDEAU",
        "first_name": "KAITLIN",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-12",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "25MP00528000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloomfield Surgi-Center, LLC
• Bloomfield Total Health Center
• Bloomfield Wellness Center
• Bloomfield Wellness Center, P.C.
• Reta Botros, PHARMACIST
• Ava Boxer, BCBA
• Serena Jane Boyce, APN
• Gail R Boyer, NP
• Sandra Marcela Boyle, PA
• Patricia A. Bradley, LPC, ED.S.

• Physician Assistant in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.