DR. ROBERT B BOURNE (NPI# 1487646998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487646998 |
| Entity Type | Individual |
| Full Name | DR. ROBERT B 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 | 8012628486 |
| 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 | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
180189-1205 | UT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | 09941 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235151630 | Robert Randall Bourne | Dentist | 1341 Mt Highway 282, Fort Harrison, MT 59636-0232 | 2006-07-24 |
| 1417985847 | Robert Cm Bourne | Family Medicine | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2006-06-28 |
| 1174513303 | Robert I Bourne Jr. | General Practice | 101 Hospital Dr, Camden, TN 38320-1617 | 2005-10-27 |
| Street Address |
1160 E 3900 S STE 5000 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84124-1275 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1275576274 | Tony Landon Miller | Physician Assistant | 1160 E 3900 S Ste 5000, Salt Lake City, UT 84124-1275 | 2006-06-14 |
| 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 | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811265044 | Lonnie Paulos Md PC | Orthopaedic Surgery | 324 East 10th Avenue, Ste 172, Salt Lake City, UT 84103-3184 | 2011-12-02 |
| 1992700330 | Leon E Paulos | Orthopaedic Surgery | 324 10th Ave, Suite 175, Salt Lake City, UT 84103-2853 | 2005-06-14 |
| 1083128730 | Kia Wilson | Orthopaedic Surgery | 375 S Chipeta Way, Salt Lake City, UT 84108-1260 | 2017-11-16 |
| 1073773107 | Andrew D Cooper Md PC | Orthopaedic Surgery | 82 S 1100 E, Suite 303, Salt Lake City, UT 84102-1686 | 2008-06-12 |
| 1396713020 | Mark David Scholl | Orthopaedic Surgery | 82 S 1100 E, Suite 303, Salt Lake City, UT 84102-1686 | 2006-03-09 |
| 1477547164 | Andrew D. Cooper | Orthopaedic Surgery | 24 S 1100 E, Salt Lake City, UT 84102-1500 | 2005-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477865491 | Ihc Health Services Inc | Orthopaedic Surgery | 1159 E 200 N Ste 100, American Fork, UT 84003-2053 | 2010-07-07 |
| 1558546739 | Mark A.rosen Md, LLC | Orthopaedic Surgery | 5911 Fashion Blvd., Suite 100, Murray, UT 84107 | 2008-01-07 |
| 1255422192 | Bruce E Thomas | Orthopaedic Surgery | 5957 Fashion Point Dr, Suite 101, Ogden, UT 84403-5180 | 2006-09-27 |
| 1922098334 | Eric A Heiden | Orthopaedic Surgery | 2200 Park Ave Bldg D, Park City, UT 84060-7246 | 2005-10-26 |
| 1366917577 | Kevin Dale Newbold | Orthopaedic Surgery | 3895 Harrison Blvd, Ogden, UT 84403-2312 | 2018-10-04 |
| 1588162283 | Alpine Management and Consulting | Orthopaedic Surgery | 2310 N 400 E Ste A, Logan, UT 84341-1796 | 2018-01-28 |
| 1154842607 | Ihc Health Services Inc | Orthopaedic Surgery | 201 W Layton Parkway, Layton, UT 84041 | 2017-07-05 |
| 1043697154 | Ihc Health Services Inc | Orthopaedic Surgery | 3895 Harrison Blvd, Ogden, UT 84403-8440 | 2015-04-28 |
| 1427456797 | Intermountain Healthcare | Orthopaedic Surgery | 652 S Medical Center Dr, Suite 120, St George, UT 84790-7049 | 2014-12-18 |
| 1962805358 | Utah Valley University | Orthopaedic Surgery | 800 W University Pkwy, Orem, UT 84058-6703 | 2014-09-30 |
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| 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.