Daniel R Bourque, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Lafayette, LA
NPI 1952393084 · NPPES record last updated Jun 20, 2023
Key facts
- NPI
- 1952393084
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 016161 (LA)
- Practice address
- 435 Heymann Blvd
Lafayette, LA 70503-2616 - Phone
- (337) 234-3344
- Fax
- (337) 234-3352
- NPI assigned
- Aug 16, 2005
- Reactivated
- Apr 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Louisiana State University School of Medicine in New Orleans, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Daniel R. Bourque, M.D., a.P.M.C.
Practice addresses (Care Compare)
435 Heymann Blvd
Lafayette, LA 70503-2616
Phone (337) 234-3344
Hospital & facility affiliations
- Ochsner Lafayette General Medical Center
- Our Lady of Lourdes Regional Medical Center, Inc
- Opelousas General Health System
- Acadia General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101101001159 | LA | Practitioner - Obstetrics/Gynecology | 3870579105 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6161 | LA | MD | Dentist |
| 016161 | LA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daniel R. Bourque, M.D., a.P.M.C. | Obstetrics & Gynecology | Current |
Accepting new patients |
| Obhg Louisiana, LLC | Obstetrics & Gynecology | Current |
Accepting new patients |
| Lafayette General Medical Center Inc | Past | Accepting new patients |
Locations
8585 Picardy Ave
Baton Rouge, LA 70809
Phone (225) 763-4000
1214 Coolidge Blvd
Lafayette, LA 70503
Phone (337) 234-9191
435 Heymann Blvd
Lafayette, LA 70503
Phone (337) 234-3344
1460 S College Rd
Lafayette, LA 70503
Phone (337) 233-3368
4200 Houma Blvd
Metairie, LA 70006
Phone (504) 454-4028
Interoperability endpoints
- https://fhir.healthtogo.me/fhir/r4/imed.bourque
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 016161 | LA | Yes |
Addresses
Primary practice location
435 Heymann Blvd
Lafayette, LA 70503-2616
Mailing address
435 Heymann Blvd
Lafayette, LA 70503-2616
Phone (337) 234-3344
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952383084 | Other | LA | INDIVIDUAL NPI |
| 1659688489 | Other | LA | GROUP NPI |
| 1345580 | Medicaid | LA | |
| 5L938DQ00 | Other | LA | INDIVIDUAL PTAN |
| 5DQ00 | Other | LA | GROUP PTAN |
Other providers in Lafayette, LA
- Gay Gele' Bourgeois
- Marc B Bourgeois
- Richard J Bourgeois
- Trysten Theresa Bourgeois
- Janna Mae Bourque Cardona
- Emily Bourque
- Hannah Gabrielle Bourque
- Jason Bourque
- Jessie Bourque
- Jodie Marie Duhon Bourque
All providers in Lafayette, LA · Obstetrics & Gynecology Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.