DR. DALTON BOURKE MD
NPI 1134623804
Psychiatry & Neurology - Child & Adolescent Psychiatry in San Antonio, TX

Q: What is Dalton Bourke's NPI number?

The NPI number for Dalton Bourke is 1134623804. It was assigned to this individual provider in the NPPES registry on March 19, 2018.

Q: What is Dalton Bourke's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Q: When was this NPI record last updated?

The NPPES record for Dalton Bourke was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.

Active since March 19, 2018PECOS Enrolled

1100 WILFORD HALL LOOP BLDG 4554, SAN ANTONIO, TX 78236(210) 292-6255(210) 292-7934 Get Directions Write a Review

NPPES record last updated: October 3, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 9, 2023, Jul 31, 2020, Mar 19, 2018 (3 updates tracked since 2018).

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About Dr. Dalton Bourke Md NPPES

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

DR. DALTON BOURKE MD (NPI 1134623804) is an individual child & adolescent psychiatry provider in San Antonio, Texas, licensed in Wisconsin (73098) and active in the NPI registry since March 2018. He is enrolled in Medicare PECOS and is a graduate of Creighton University School Of Medicine (2018).

NPPES Registry Identity

NPI1134623804

Entity TypeIndividualMale

Primary Taxonomy2084P0804X

Provider Legal NameDR. DALTON BOURKECredential: MD

Location Address1100 WILFORD HALL LOOP BLDG 4554San Antonio, TX 78236-5638

Mailing Address1100 Wilford Hall Loop Bldg 4554San Antonio, TX 78236-5638 · (210) 292-6255 · Fax (210) 292-7934

Phone(210) 292-6255

Fax(210) 292-7934

Sole ProprietorNo

Medical School CMSCreighton University School Of MedicineGraduated 2018

Enumeration DateMarch 19, 2018

Last NPPES UpdateOctober 3, 20253 updates tracked since enumeration

NPPES CertifiedOctober 3, 2025

✔ NPI 1134623804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · Child & Adolescent PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0804X

License✔ Licensed in WI · 73098

Definition

Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 73098 (WI)

1100 WILFORD HALL LOOP BLDG 4554, San Antonio, TX 78236

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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)

Dr. Dalton Bourke Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6406104611

PECOS Enrollment IDI20260612003539

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.

Other Providers at the Same Location NPPES 20

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

DR. REGINA MARIA REINSVOLD M.D.

Anesthesiology

1100 WILFORD HALL LOOP BLDG 4554
LACKLAND AFB, TX 78236

Bexar County (210) 292-6255

ROBERT LEE LMFT

Marriage & Family Therapist

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND, TX 78236

Bexar County (210) 292-6255

DR. FINIANNE JIMENEZ UMALI-CORRY DO, MPH

Internal Medicine

1100 WILFORD HALL LOOP BLDG 4554
LACKLAND AFB, TX 78236

Bexar County (210) 292-4277

DAVID CHRISTOPHER MARI D.O.

Allergy & Immunology

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND, TX 78236

Bexar County (210) 292-6255

DR. HANNAH GHONG-JU AHN MD

Radiology (Diagnostic Radiology)

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND, TX 78236

Bexar County (210) 292-4482

MRS. CASSANDRA LANETTE DOUGLAS PHARMACIST

Pharmacist

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND, TX 78236

Bexar County (102) 292-1144

DR. CHARLES RICHARD ELCHERT JR. D.C.

Chiropractor

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND, TX 78236

Bexar County (210) 292-3587

DR. LISA LEADER KOHLER OD

Optometrist

1100 WILFORD HALL LOOP BLDG 4554
JBSA LACKLAND, TX 78236

Bexar County (210) 292-6255

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 Dalton Bourke's NPI number?

The NPI number for Dalton Bourke is 1134623804. It was assigned to this individual provider in the NPPES registry on March 19, 2018.

Where is Dalton Bourke located?

Dalton Bourke practices at 1100 Wilford Hall Loop Bldg 4554, San Antonio, TX 78236. The listed phone number is (210) 292-6255.

What is Dalton Bourke's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Child & Adolescent Psychiatry, with taxonomy code 2084P0804X.

Is Dalton Bourke enrolled in Medicare?

Yes. Dalton Bourke is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Dalton Bourke was last updated on October 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.