Theresa Alice Bullock, M.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34008388A Issued in IN

Practice address

526 N Oriental St
Indianapolis, IN 46202-3559

Phone

(336) 414-2508

NPI assigned

Feb 14, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Indiana University Health Care Associates, Inc

  dba IU Health Physicians

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1902032832
  NPD (past)

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

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584921600000",
    "number": "1023381613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 N ORIENTAL ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023559",
            "telephone_number": "336-414-2508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 N ORIENTAL ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462023559",
            "telephone_number": "336-414-2508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "THERESA",
        "middle_name": "ALICE",
        "name_prefix": "Ms.",
        "credential": "M.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-14",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34008388A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023381613",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Lynn Bullock
• Kaylie Ashlynn Bullock, MD
• Mary Bullock
• Megan Bullock, LMHC, CSAYC
• Tamara Latrice Bullock
• Brenda A Bullocks-Fox
• Karen L. Bumb, MD
• Courtney N Bumbalough, FNP-C
• Dennis Michael Bumgarner, L.C.S.W.
• Angel Renee Bumphus

• Clinical Social Worker in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.