PETER RALPH BOURQUE JR. MS, APRN, PMHNP-BC
NPI 1972853299
Nurse Practitioner - Psychiatric/Mental Health in Bohemia, NY

Q: What is Peter Bourque's NPI number?

The NPI number for Peter Bourque is 1972853299. It was assigned to this individual provider in the NPPES registry on September 13, 2012. The provider is also known as Peter R Bourque Ms, Aprn, Pmhnp-Bc.

Q: What is Peter Bourque's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: Is Peter Bourque enrolled in Medicare?

No. Peter Bourque has opted out of Medicare through January 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Peter Bourque was last updated on January 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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 September 13, 2012Opted out of Medicare · through Jan 1, 2027

1650 SYCAMORE AVE STE 39, BOHEMIA, NY 11716(631) 213-1770(631) 315-8042 Get Directions Write a Review

NPPES record last updated: January 31, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 31, 2026, Jan 15, 2026, Oct 1, 2024 (3 updates tracked since 2024).

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About Peter Ralph Bourque Jr. Ms, Aprn, Pmhnp-bc NPPES

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

PETER RALPH BOURQUE JR. MS, APRN, PMHNP-BC (NPI 1972853299) is an individual psychiatric/mental health provider in Bohemia, New York, licensed in New York (F402626) and active in the NPI registry since September 2012. He has opted out of Medicare through January 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1972853299

Entity TypeIndividualMale

Primary Taxonomy363LP0808X

Provider Legal NamePETER RALPH BOURQUE JR.Credential: MS, APRN, PMHNP-BC

Location Address1650 SYCAMORE AVE STE 39Bohemia, NY 11716-1736

Mailing Address1650 Sycamore Ave Ste 39Bohemia, NY 11716-1736 · (631) 213-1770 · Fax (631) 315-8042

Phone(631) 213-1770

Fax(631) 315-8042

Sole ProprietorYes

Enumeration DateSeptember 13, 2012

Last NPPES UpdateJanuary 31, 20263 updates tracked since enumeration

NPPES CertifiedJanuary 31, 2026

✔ NPI 1972853299 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in NY · F402626

Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License 525838 (NY)

1650 SYCAMORE AVE STE 39, Bohemia, NY 11716

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Other Names 1

Other Name (5)Peter R Bourque Ms, Aprn, Pmhnp-bc

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Peter Ralph Bourque Jr. Ms, Aprn, Pmhnp-bc has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2017 through January 1, 2027.

Opt-Out Effective DateJanuary 1, 2017

Opt-Out In Effect ThroughJanuary 1, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11716 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

$105.06 typical visit price

range $67.40 – $203.53

Typical copayment $26.26 (range $16.85 – $50.88)

Most-billed visit code 99203

Established Patient

$117.62 typical visit price

range $21.66 – $164.45

Typical copayment $29.40 (range $5.41 – $41.11)

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 17

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

KRISTINE MENNA LCAT

Counselor