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MR. KENRICK CARLYLE BOURNE PA-C
NPI 1063690931
Physician Assistant in San Jacinto, CA

Active since February 04, 2008PECOS Enrolled
1695 S SAN JACINTO AVE STE C, SAN JACINTO, CA 92583(951) 330-3100(951) 380-8596 Get Directions Write a Review

NPPES record last updated: October 4, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 4, 2024, Sep 16, 2024 (2 updates tracked since 2024).

About Mr. Kenrick Carlyle Bourne Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KENRICK CARLYLE BOURNE PA-C (NPI 1063690931) is an individual physician assistant in San Jacinto, California, licensed in California (PA12018) and active in the NPI registry since February 2008. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1063690931
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. KENRICK CARLYLE BOURNECredential: PA-C
Location Address1695 S SAN JACINTO AVE STE CSan Jacinto, CA 92583-5103
Mailing Address1695 S San Jacinto AveSan Jacinto, CA 92583-5103 · (951) 330-3100
Phone(951) 330-3100
Fax(951) 380-8596
Sole ProprietorYes
Enumeration DateFebruary 4, 2008
Last NPPES UpdateOctober 4, 20242 updates tracked since enumeration
NPPES CertifiedOctober 4, 2024
✔ NPI 1063690931 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · PA12018
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1695 S SAN JACINTO AVE STE C, San Jacinto, CA 92583
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Kenrick Carlyle Bourne Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92583 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$74.08 typical visit price
range $19.37 – $146.42
Typical copayment $18.52 (range $4.84 – $36.60)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MERA HASHWANI PT, DPT
Physical Therapist
1695 S SAN JACINTO AVE STE C
SAN JACINTO, CA 92583
Riverside County (951) 665-1515
SHRUTI J AMIN DPT
Physical Therapist
1695 S SAN JACINTO AVE STE C
SAN JACINTO, CA 92583
Riverside County (951) 696-9353

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenrick Bourne's NPI number?

The NPI number for Kenrick Bourne is 1063690931. It was assigned to this individual provider in the NPPES registry on February 4, 2008.

Where is Kenrick Bourne located?

Kenrick Bourne practices at 1695 S San Jacinto Ave Ste C, San Jacinto, CA 92583. The listed phone number is (951) 330-3100.

What is Kenrick Bourne's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Kenrick Bourne enrolled in Medicare?

Yes. Kenrick Bourne is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kenrick Bourne was last updated on October 4, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.