KELLY BOURGON OD
NPI 1194213751
Optometrist in Longmont, CO

Q: What is Kelly Bourgon's NPI number?

The NPI number for Kelly Bourgon is 1194213751. It was assigned to this individual provider in the NPPES registry on April 28, 2018.

Q: What is Kelly Bourgon's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Q: When was this NPI record last updated?

The NPPES record for Kelly Bourgon was last updated on January 30, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.

Active since April 28, 2018PECOS EnrolledAccepts Medicare Assignment

412 MAIN ST, LONGMONT, CO 80501(303) 651-6700 Get Directions Write a Review

NPPES record last updated: January 30, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 30, 2023, Jul 26, 2018, Apr 28, 2018 (3 updates tracked since 2018).

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About Kelly Bourgon Od NPPES

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

KELLY BOURGON OD (NPI 1194213751) is an individual optometrist in Longmont, Colorado, licensed in Colorado (3557) and active in the NPI registry since April 2018. She is enrolled in Medicare PECOS and is a graduate of Pacific University - College Of Optometry (2018).

NPPES Registry Identity

NPI1194213751

Entity TypeIndividualFemale

Primary Taxonomy152W00000X

Provider Legal NameKELLY BOURGONCredential: OD

Location Address412 MAIN STLongmont, CO 80501-5535

Mailing Address1768 S Taft Ave Apt 103Loveland, CO 80537-7291 · (207) 356-5387

Phone(303) 651-6700

Sole ProprietorNo

Medical School CMSPacific University - College Of OptometryGraduated 2018

Enumeration DateApril 28, 2018

Last NPPES UpdateJanuary 30, 20233 updates tracked since enumeration

NPPES CertifiedJanuary 30, 2023

✔ NPI 1194213751 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

Licenses✔ Licensed in CO · 3557✔ Licensed in NY · TUV008844

Definition

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

412 MAIN ST, Longmont, CO 80501

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Bourgon Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4981955895

PECOS Enrollment IDI20200917003222

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.

Areas of Expertise CMS Part B claims 5

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Photography of the retina 92250

Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.

57 services52 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

34 services28 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

28 services28 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

18 services15 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 80501 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

$132.55 typical visit price

range $58.06 – $174.82

Typical copayment $33.13 (range $14.51 – $43.70)

Most-billed visit code 99204

Established Patient

$72.20 typical visit price

range $18.88 – $142.79

Typical copayment $18.05 (range $4.72 – $35.69)

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 5

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

LONGMONT VISION CENTER LLC

Optometrist