NPIMap

Individual provider Active NPI

Sonya Simmons Bullock, PA-C

  • Physician Assistant
  • Bailey, NC
National Provider Identifier
1013915388
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
104090 Issued in NC
Practice address
6321 Deans Street Bailey Primary Care
Bailey, NC 27807
Phone
(252) 235-4181
Fax
(252) 308-0872
NPI assigned
Jul 12, 2005
Last updated
Mar 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 104090 NC Primary
Medical Physician Assistant 363AM0700X 104090 NC

Addresses

Primary practice location

6321 Deans Street Bailey Primary Care
Bailey, NC 27807

Mailing address

1700 Tarboro Street SW Ste 103
Wilson, NC 27893
Phone (252) 308-0686

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101008000380 NC Practitioner - Physician Assistant 7911199989 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Health Group IncGroup PAC ID 9739090226, shared by 19 NPIs, 65 clinicians

Practice addresses (Care Compare)

2064 NC Hwy 125
Roanoke Rapids, NC 27870-9436
Phone (252) 536-5000

2066 NC Hwy 125
Roanoke Rapids, NC 27870-9436
Phone (252) 536-5000

PO Box
Roanoke Rapids, NC 27870

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
104090NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Group, Inc. CurrentSince Aug 21, 2023 Accepting new patients
Rural Health Group, Inc. CurrentSince Dec 3, 2023 Accepting new patients
Rural Health Group, Inc. CurrentSince Aug 21, 2023 Accepting new patients
Rural Health Group, Inc. Current Accepting new patients
Rural Health Group, Inc. CurrentSince Dec 3, 2023 Accepting new patients
DLP Wilson Physician Practices LLC Physician Assistant CurrentSince Jan 4, 2021 Accepting new patients
DLP Wilson Physician Practices LLC CurrentSince Jan 4, 2021 Accepting new patients
Rural Health Group, Inc. Past Accepting new patients
Rural Health Group, Inc. Past Accepting new patients

Locations

6321 Deans St
Bailey, NC 27807
Phone (202) 235-4181

1096 E 10th St
Roanoke Rapids, NC 27870
Phone (252) 535-3516

1381 Medical Center Dr
Roanoke Rapids, NC 27870
Phone (252) 535-1414

2066 NC Highway 125
Roanoke Rapids, NC 27870
Phone (252) 536-5000

250 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-9699

270 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-6816

1700 Tarboro St W
Ste 103
Wilson, NC 27893
Phone (252) 293-9898

2605 Forest Hills Rd SW
Ste A
Wilson, NC 27893
Phone (252) 243-0043

Interoperability endpoints

  • Direct secure messaging: sonya.bullock.1@9600.direct.athenahealth.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1013915388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 TARBORO STREET SW STE 103",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "27893",
            "telephone_number": "252-308-0686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6321 DEANS STREET BAILEY PRIMARY CARE",
            "city": "BAILEY",
            "state": "NC",
            "postal_code": "27807",
            "telephone_number": "252-235-4181",
            "fax_number": "252-308-0872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "SONYA",
        "middle_name": "SIMMONS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "104090",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "104090",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bailey, NC

Sources for this page

Verify at the official NPI Registry.