Active NPI 1194213751 Individual Practitioner Female Practitioner

Dr. Kelly Bourgon , OD

Optometrist • Longmont, CO

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Kelly Bourgon, OD is a certified Optometrist practicing in Longmont, CO. With approximately 8 years of clinical experience since graduating from Pacific University - College Of Optometry in 2018, Dr. Bourgon delivers high-quality medical care to the local community at 412 MAIN ST.

Dr. Bourgon is affiliated with Eye Care Associates Of Co Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include photography of the retina, established patient outpatient office visit, new patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

412 Main St

Longmont, CO 805015535

Telephone 3036516700

Associated Practice Facility / Clinic

🏢 Longmont Vision Center Llc Facility NPI 1043325806

Medicare Profile & Education

Medical School

Pacific University - College Of Optometry

Graduation Year

2018

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Optometrist in Longmont, CO

Experienced Practitioner (5-10 Yrs)

Practitioner Clinical Experience

8 Yrs -8.8 yrs vs City Avg

City Avg: 16.8 Yrs

State Avg: 19.9 Yrs

Regional Practice Density

29 Specialists

Practicing in Longmont, CO (1307 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

49.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Bourgon (8 Years) 8 Yrs

Longmont Specialty Average (16.8 Years) 16.8 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
92250 Photography of the retina	57	52	$101.05	$37.49
99213 Established patient office or other outpatient visit, typically 15 minutes	34	28	$172.35	$91.20
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	28	28	$252.50	$129.31
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	18	15	$110.67	$56.85
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$320.00	$167.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	66	65	$105.00	$91.30
92250 Photography of the retina	39	38	$110.00	$38.19
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	33	25	$78.00	$57.33

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	28	23	$90.00	$57.98
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	24	$140.00	$130.97
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	17	17	$200.00	$169.71
92014 Established patient complete exam of visual system	17	17	$167.06	$131.00
92004 New patient complete exam of visual system	12	12	$195.00	$154.36
92250 Photography of the retina	11	11	$130.00	$38.18

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	28	28	$144.29	$133.62
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	22	22	$200.00	$172.34
92014 Established patient complete exam of visual system	21	21	$168.10	$132.25
92004 New patient complete exam of visual system	20	20	$195.00	$156.72
92134 Imaging of retina	14	13	$102.14	$41.68

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
92014 Established patient complete exam of visual system	49	49	$226.10	$120.97
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	35	29	$200.00	$105.82
99213 Established patient office or other outpatient visit, typically 15 minutes	32	21	$125.00	$72.77
92250 Photography of the retina	20	20	$150.00	$42.99
92012 Established patient problem focused exam of visual system	19	19	$160.00	$86.37
92004 New patient complete exam of visual system	18	18	$227.33	$152.84
92020 Examination of cornea and iris using lens device and slit lamp	18	18	$53.00	$24.16
68761 Closure of tear duct opening using plug	17	17	$470.59	$208.05
92133 Imaging of optic nerve	15	15	$128.00	$33.07
92134 Imaging of retina	15	15	$128.00	$36.45
92083 Exam of visual field with extended testing	15	15	$171.33	$57.49

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	163	133	$125.00	$71.39
92012 Established patient problem focused exam of visual system	98	86	$160.00	$85.16
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	72	62	$200.00	$104.60
92134 Imaging of retina	45	42	$130.00	$39.29
68761 Closure of tear duct opening using plug	45	29	$483.33	$212.30
92250 Photography of the retina	40	40	$150.00	$47.90
92083 Exam of visual field with extended testing	37	33	$175.00	$61.77
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	31	31	$200.00	$101.74
92133 Imaging of optic nerve	30	30	$130.00	$34.58
92014 Established patient complete exam of visual system	29	29	$243.00	$122.13
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	18	$100.00	$43.20
92004 New patient complete exam of visual system	17	17	$292.00	$146.21
76514 Ultrasound scan of cornea to determine thickness	11	11	$75.00	$11.32

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	14	14	$125.00	$70.16
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	12	$100.00	$42.08

Medical Specialties & State Licenses

CMS Verified: 2023-01-30

Optometrist Primary Specialty

NUCC Taxonomy Code: 152W00000X

State License CO 3557

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.

Optometrist

NUCC Taxonomy Code: 152W00000X

State License NY TUV008844

Hospital & Practice Group Affiliations

Eye Care Associates Of Co Llc

412 Main St, Longmont, CO 805015535

Phone: 3036516700

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners

Dr. Phillip Baker , OD

Optometrist

NPI 1386708659

Doctor of Optometry

Dr. Roger Trudell , OD

Optometrist

NPI 1447314703

Doctor of Optometry

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

📍

Updated Practice Location January 30, 2023

Registered at 412 MAIN ST, LONGMONT, CO 805015535 (Tel: 3036516700)

📍

Updated Business Mailing Address January 30, 2023

Registered at 1768 S TAFT AVE APT 103, LOVELAND, CO 805377291 (Tel: 2073565387)

👤

Provider Name / Credentials Updated January 30, 2023

Recorded as KELLY BOURGON, OD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 30, 2023

Optometrist (License #TUV008844 in NY)

📍

Updated Practice Location July 26, 2018

Registered at 1815 STATE ST, WATERTOWN, NY 13601 (Tel: 3157886070)

✅

NPI Profile Active April 28, 2018

NPI status registered as active in NPPES database

📍

Updated Practice Location April 28, 2018

Registered at 1815 STATE ST, WATERTOWN, NY 136019407 (Tel: 3157886070)

📍

Updated Business Mailing Address April 28, 2018

Registered at 9 HARBOR DR, BREWER, ME 044122534 (Tel: 2073565387)

👤

Provider Name / Credentials Updated April 28, 2018

Recorded as KELLY BOURGON

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 28, 2018

Student in an Organized Health Care Education/Training Program

🟢

Initial NPI Registration & Enumeration April 28, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1194213751

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: April 28, 2018

Last Update: January 30, 2023

Sole Proprietor: No

Update or Correct Profile

Mailing Address

1768 S Taft Ave Apt 103

Loveland, CO 805377291

Phone: 2073565387

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.