DR. MICHAEL H BOURNE (NPI# 1073505582) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073505582 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL H BOURNE |
| Credential | MD |
| Practice Address |
1160 E 3900 S Ste 5000 Salt Lake City UT 84124-1275 |
| Mailing Address |
Po Box 100253 Atlanta GA 30384-0253 |
| Practice Telephone | 8012617479 |
| Practice Fax Number | 8012617429 |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2020-05-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
1818921205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 09941 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710546965 | Michael William Bourne | Internal Medicine | The Gw Medical Faculty Associates, 2150 Pennsylvania Avenue, Nw, Washington, DC 20037 | 2019-06-11 |
| 1992178347 | Michael Bourne | Social Worker | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2015-11-06 |
| 1881030443 | Michael Hal Bourne Jr. | Internal Medicine | 9427 Sw Barnes Rd Ste 296, Portland, OR 97225-6667 | 2013-05-22 |
| 1164412649 | Michael Ray Bourne | Podiatrist | 1500 Curve Crest Blvd W, Stillwater, MN 55082 | 2005-10-25 |
| Street Address |
1160 E 3900 S STE 5000 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84124-1275 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487646998 | Robert B Bourne | Orthopaedic Surgery | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2005-08-19 |
| 1407407679 | Francisco Jose Hurtado Iv | Physician Assistant | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2019-09-27 |
| 1578118659 | Robert Derrel Johnstun | Orthopaedic Surgery | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2019-08-06 |
| 1508424870 | Alex Ann Anderson | Physical Therapist | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2019-06-03 |
| 1811488976 | Alexa Victoria Nickel | Registered Nurse | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2018-05-24 |
| 1679002190 | Chase Naylor | Physician Assistant | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2017-06-08 |
| 1063764629 | Craig Robert Schumann | Physician Assistant | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2012-10-08 |
| 1700149572 | Oliver Brant Nikolaus | Orthopaedic Surgery | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2012-06-18 |
| 1992859524 | David P Stefl | Physician Assistant | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2007-01-22 |
| 1033123179 | Jeffrey D Jackson | Orthopaedic Surgery | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2006-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487273298 | Shannon Penny Price | Social Worker | 4465 Maybeck Place, Condo C, Millcreek, UT 84124 | 2020-04-11 |
| 1922654367 | Joseph C Melvin Md PC | Colon & Rectal Surgery | 1250 East 3900 South Ste 320, Salt Lake City, UT 84124 | 2019-08-12 |
| 1366923252 | Melanie Stumpf | Counselor | 1141 E 3900, Suite A170, Salt Lake City, UT 84124 | 2018-08-28 |
| 1376033993 | Michelle Flowers | Speech-Language Pathologist | 2120 East 3900 South, Ste 200, Holladay, UT 84124 | 2018-05-18 |
| 1740797257 | Lissa Anne Hutchings | Nurse Practitioner | 1160 E 3900 S Ste 4100, Salt Lake City, UT 84124 | 2018-01-05 |
| 1316465693 | Randy Gines | Counselor | 4460 S Highland Drive # 230, Murray, UT 84124 | 2017-09-06 |
| 1417470717 | Joshua Chandler Spencer | Counselor | 4460 South Highland Dr., 230, Murray, UT 84124 | 2017-07-19 |
| 1659891554 | Marcus Whitney | Counselor | 4460 S Highland Dr. # 230, Murray, UT 84124 | 2017-06-21 |
| 1518496884 | Courtney Nilson | Counselor | 4460 S. Highland Dr. #230, Murray, UT 84124 | 2017-06-08 |
| 1841687126 | Intrafilrx | Preferred Provider Organization | 3920 S 1100 E Ste 210, Salt Lake City, UT 84124 | 2015-04-23 |
| Find all providers in zip 84124 | ||||
| Taxonomy Code | 207XS0114X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Adult Reconstructive Orthopaedic Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942292446 | Bruce G Evans | Orthopaedic Surgery | 1160 East 3900 South, Suite 5000, Salt Lake City, UT 84124-1275 | 2005-08-19 |
| 1740676394 | Matthew C. Christie | Orthopaedic Surgery | 590 S Wakara Way, Salt Lake City, UT 84108-1200 | 2015-04-10 |
| 1437579893 | Steven Donohoe | Orthopaedic Surgery | 590 S Wakara Way, Salt Lake City, UT 84108-1200 | 2014-04-23 |
| 1548410608 | G Lynn Rasmussen Md PC | Orthopaedic Surgery | 5848 Fashion Blvd Ste 110, Salt Lake City, UT 84107-6121 | 2008-09-25 |
| 1366624991 | Nathan G Momberger Md PC | Orthopaedic Surgery | 5848 Fashion Blvd Ste 110, Salt Lake City, UT 84107-6121 | 2007-12-05 |
| 1568456242 | Kim C Bertin | Orthopaedic Surgery | 24 S 1100 E, Ste 101, Salt Lake City, UT 84102-1500 | 2005-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083953558 | Russell L Nelson, M.d. PC | Orthopaedic Surgery | 5323 S Woodrow St Ste 200, Murray, UT 84107-5844 | 2013-02-04 |
| 1669416129 | John M Hillyard | Orthopaedic Surgery | 1899 E Mystic Grove Cv, Cottonwood Heights, UT 84093-5509 | 2006-06-15 |
| 1063645554 | Yvonne Potter Fuellenbach | Orthopaedic Surgery | 5848 Fashion Blvd Ste 110, Murray, UT 84107-6121 | 2009-08-31 |
| 1326286972 | Peter G. Larcom Md PC | Orthopaedic Surgery | 5323 South Woodrow Street Suite 200, Murray, UT 84107 | 2009-02-04 |
| 1366460420 | G Lynn Rasmussen | Orthopaedic Surgery | 5848 Fashion Blvd Ste 110, Murray, UT 84107-6121 | 2006-07-17 |
| 1467486795 | Nathan G Momberger | Orthopaedic Surgery | 5848 Fashion Blvd Ste 110, Murray, UT 84107-6121 | 2006-07-11 |
| 1821029869 | Peter G Larcom | Orthopaedic Surgery | 5316 S Woodrow St Ste 200, Murray, UT 84107-5838 | 2006-07-06 |
| City | SALT LAKE CITY |
| Zip Code | 84124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.