NPIMap

Individual provider Active NPI

Johnny Bullock, MD

  • Family Medicine Physician
  • Foxworth, MS
National Provider Identifier
1043268709
Registry record updated Nov 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
13883 Issued in MS
Practice address
62 Highway 587
Foxworth, MS 39483-5026
Phone
(601) 424-3540
Fax
(601) 424-3544
NPI assigned
May 5, 2006
Last updated
Nov 1, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 13883 MS Primary

Addresses

Primary practice location

62 Highway 587
Foxworth, MS 39483-5026

Mailing address

PO Box 669
Foxworth, MS 39483-0669
Phone (601) 424-3540

Other identifiers 1

IdentifierTypeStateIssuer
00737837MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20041006000254 MS Practitioner - Internal Medicine 3971562976 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Mississippi School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Walthall General HospitalGroup PAC ID 3678766094, 7 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Tylertown, MS 39667-2022
Phone (601) 876-2122

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
RH Hospitalist Medicine of Walthall General LLC CurrentSince May 1, 2024 Accepting new patients
Medical Services of Meridian, Inc. CurrentSince Apr 1, 2019 Accepting new patients
RH Hospitalist Medicine of Jefferson Davis LLC CurrentSince May 1, 2024 Accepting new patients
Keystone Medical Services of Ms, Inc CurrentSince Nov 3, 2012 Accepting new patients
Walthall General Hospital CurrentSince Jul 8, 2017 Accepting new patients
Walthall General Hospital CurrentSince Jul 8, 2017 Accepting new patients
RH Emergency Medicine of Walthall General LLC CurrentSince May 1, 2024 Accepting new patients
RH Emergency Medicine of Jefferson Davis LLC CurrentSince May 1, 2024 Accepting new patients
The Clinic at Farmers Medshoppe CurrentSince Apr 16, 2012 Accepting new patients
Walthall General Hospital Past Accepting new patients
Marion General Hospital Past Accepting new patients
Walthal Rural Health Clinic Past Accepting new patients
Internal Medicine Clinic of Columbia, P.a. PastSince Nov 5, 2019 Accepting new patients
Walthall Rural Health Clinic Family Medicine Past Accepting new patients

Locations

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

62 Highway 587
Foxworth, MS 39483
Phone (601) 424-3540

2124 14th St
Meridian, MS 39301
Phone (601) 483-8811

1102 Rose St
Prentiss, MS 39474
Phone (601) 792-2947

100 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-0455

200 Hospital Dr
Tylertown, MS 39667
Phone (601) 876-5303

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 8

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": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1043268709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 669",
            "city": "FOXWORTH",
            "state": "MS",
            "postal_code": "394830669",
            "telephone_number": "601-424-3540",
            "fax_number": "601-424-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 HIGHWAY 587",
            "city": "FOXWORTH",
            "state": "MS",
            "postal_code": "394835026",
            "telephone_number": "601-424-3540",
            "fax_number": "601-424-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "JOHNNY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "13883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00737837",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Foxworth, MS

Sources for this page

Verify at the official NPI Registry.