Danielle Marie Bourque, RD, LDN, CD-N

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

001634 Issued in CT

Practice address

470 Main St
Wilbraham, MA 01095-2900

Phone

(413) 258-0010

NPI assigned

Feb 12, 2019

Last updated

Feb 12, 2019By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, CT2 enrollments

Enrollment records 2

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brockton Neighborhood Health CenterGroup PAC ID 3870491699, shared by 2 NPIs, 68 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et1290.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Brockton Neighborhood Health Center

  • Federally Qualified Health Center (FQHC)
  • Brockton, MA
  • NPI 1225085319
  Medicare reassignment NPD
• Wellpoint Health Solutions, LLC

  • Registered Dietitian
  • Wilbraham, MA
  • NPI 1336663798
  Medicare reassignment
• Brockton Neighborhood Health Center, Inc.

  dba BNHC Pharmacy

  • Community/Retail Pharmacy
  • Brockton, MA
  • NPI 1528704061
  NPD

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

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1831655059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 MAIN ST",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010952900",
            "telephone_number": "860-818-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 MAIN ST",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010952900",
            "telephone_number": "413-258-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUE",
        "first_name": "DANIELLE",
        "middle_name": "MARIE",
        "credential": "RD, LDN, CD-N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-12",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": "001634",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "4448",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "001634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Big Y Foods Inc (Big Y Pharmacy #86)
• Eric R Bissonnette
• Susan Gail Bloomberg, OTR/L
• William Bonavita, P.T.
• Leonard R Borsari, PH.D.
• Hannah Bowen
• Michael W Bowler, RPH
• Halina Boyer, COTA
• Joseph M Boyle, DC
• Valerie Brach-Bonkowski, SLP

• Registered Dietitian in Wilbraham, MA
• Providers in Wilbraham, MA by specialty
• Registered Dietitian in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.