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DR. JEFFREY PHILIP BOURNE M.D.
NPI 1164569091
Pediatrics in Los Angeles, CA

Active since January 31, 2007PECOS Enrolled
12555 W JEFFERSON BLVD STE 302, LOS ANGELES, CA 90066(424) 443-5600(424) 443-5600 Get Directions Write a Review

NPPES record last updated: March 29, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 29, 2021, Aug 14, 2020, Jan 8, 2019 and 2 more (5 updates tracked since 2018).

About Dr. Jeffrey Philip Bourne M.d. NPPES

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

DR. JEFFREY PHILIP BOURNE M.D. (NPI 1164569091) is an individual pediatrics provider in Los Angeles, California, licensed in California (G86941) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS and maintains a secondary practice location in Santa Monica.

NPPES Registry Identity

NPI1164569091
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. JEFFREY PHILIP BOURNECredential: M.D.
Location Address12555 W JEFFERSON BLVD STE 302Los Angeles, CA 90066-7032
Mailing Address1811 Wilshire Blvd Ste 110Santa Monica, CA 90403-5626 · (310) 453-9010 · Fax (310) 828-3661
Phone(424) 443-5600
Fax(424) 443-5600
Sole ProprietorNo
Enumeration DateJanuary 31, 2007
Last NPPES UpdateMarch 29, 20215 updates tracked since enumeration
NPPES CertifiedMarch 29, 2021
✔ NPI 1164569091 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Licenses✔ Licensed in CA · G86941✔ Licensed in FL · ME66931
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
12555 W JEFFERSON BLVD STE 302, Los Angeles, CA 90066
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Secondary Practice Location 1

Location 11811 Wilshire Blvd Ste 110Santa Monica, CA 90403-5626 · Phone (310) 453-9010 · Fax (310) 828-3661

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jeffrey Philip Bourne M.d. 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.

Medicare Billing Reassignment

Medicare enrollment records show Jeffrey Bourne reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Providence Saint Johns Medical Foundation
5.1 mi
Specialist
2121 SANTA MONICA BLVD
Santa Monica, CA 90404
  • Reassigned Medicare billing, California enrollment
  • 461 clinicians in this Medicare group
NPI 1770093734 (310) 582-7312

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90066 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
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
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 5

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

DANIELLE ELIZABETH FERNANDES M.D.
Pediatrics
12555 W JEFFERSON BLVD STE 302
LOS ANGELES, CA 90066
Los Angeles County (424) 443-5600
VANIA THANH NGUYEN M.D.
Pediatrics
12555 W JEFFERSON BLVD STE 302
LOS ANGELES, CA 90066
Los Angeles County (424) 443-5600
MRS. DANELLE M FISHER MD
Pediatrics
12555 W JEFFERSON BLVD STE 302
LOS ANGELES, CA 90066
Los Angeles County (424) 443-5600
DR. DANIEL ING PAK LAU M.D.
Pediatrics
12555 W JEFFERSON BLVD STE 302
LOS ANGELES, CA 90066
Los Angeles County (424) 443-5600
DR. AMY MARA SHAPIRO M.D.
Pediatrics
12555 W JEFFERSON BLVD STE 302
LOS ANGELES, CA 90066
Los Angeles County (424) 443-5600

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 Jeffrey Bourne's NPI number?

The NPI number for Jeffrey Bourne is 1164569091. It was assigned to this individual provider in the NPPES registry on January 31, 2007.

Where is Jeffrey Bourne located?

Jeffrey Bourne practices at 12555 W Jefferson Blvd Ste 302, Los Angeles, CA 90066. The listed phone number is (424) 443-5600.

What is Jeffrey Bourne's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Jeffrey Bourne enrolled in Medicare?

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

Which organization bills Medicare for Jeffrey Bourne's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jeffrey Bourne reassigns Medicare benefits to Providence Saint Johns Medical Foundation (Santa Monica, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jeffrey Bourne's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jeffrey Bourne was last updated on March 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.