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Individual provider Active NPI

Charlotte Bourdillon, MD

  • Family Medicine Physician
  • Ventura, CA
National Provider Identifier
1972163889
Registry record updated Dec 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
183154 Issued in CA
Practice address
300 Hillmont Ave
BLDG 340, Suite 201
Ventura, CA 93003-1651
Phone
(805) 652-6100
NPI assigned
Jun 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 183154 CA Primary

Addresses

Primary practice location

300 Hillmont Ave
BLDG 340, Suite 201
Ventura, CA 93003-1651

Mailing address

800 S Victoria Ave # L4615
Ventura, CA 93009-0003
Phone (805) 677-5181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230324002316 TX Practitioner - Family Practice 9931573367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Michigan Medical School, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Alaska Regional Health ConsortiumGroup PAC ID 1456265362, 373 clinicians

Practice addresses (Care Compare)

1204 Seward Ave
Searhc 1204 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1206 Seward Ave
Searhc 1206 Behavioral Health Sitka
Sitka, AK 99835-7359
Phone (907) 966-8611

1209 Seward Ave
Searhc 1209 Behavioral
Sitka, AK 99835-7359
Phone (907) 966-8611

222 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

227 Tongass Dr
Sitka, AK 99835-9416
Phone (907) 966-2411

Hospital & facility affiliations

  • Southeast Alaska Regional Health Consortium Hospital, Sitka, AK, CCN 021314
  • Southeast Alaska Regional Health Consortium Nursing home, CCN 02Z314

Merit-based Incentive Payment System (MIPS)

Final score
79.12 of 100Reported as group
Quality
81.91
Promoting interoperability
100
Improvement activities
40
Cost
40.93

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
183154CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South East Alaska Regional Health Consortium CurrentSince Feb 28, 2023 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients
Southeast Alaska Regional Health Consortium CurrentSince Feb 28, 2023 Accepting new patients
Southeast Alaska Regional Health Consortium Current Accepting new patients

Locations

3100 Channel Dr
Ste 300
Juneau, AK 99801
Phone (907) 463-4000

222 Tongass Dr
Sitka, AK 99835
Phone (907) 966-8423

Interoperability endpoints

  • Direct secure messaging: cbourdillon@direct-searhc.org

Organizations & group practices 4

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 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1972163889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S VICTORIA AVE # L4615",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930090003",
            "telephone_number": "805-677-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 HILLMONT AVE",
            "address_2": "BLDG 340, SUITE 201",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031651",
            "telephone_number": "805-652-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURDILLON",
        "first_name": "CHARLOTTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "183154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.