Active NPI
David Alexander Bullock
- Social Worker
- Southfield, MI
National Provider Identifier
1053960047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 17320 W 12 Mile Rd Ste 101
Southfield, MI 48076-2102 - Phone
- (734) 330-3663
- Fax
- (248) 557-4697
- NPI assigned
- Sep 11, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
17320 W 12 Mile Rd Ste 101
Southfield, MI 48076-2102
Mailing address
17320 W 12 Mile Rd Ste 101
Southfield, MI 48076-2102
Phone (734) 330-3663
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | dbullocksw@gmail.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Live Well Counseling and Behavioral Health | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Ann Arbor, MI
- NPI 1154168821
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1053960047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17320 W 12 MILE RD STE 101",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480762102",
"telephone_number": "734-330-3663",
"fax_number": "248-557-4697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17320 W 12 MILE RD STE 101",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480762102",
"telephone_number": "734-330-3663",
"fax_number": "248-557-4697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "DAVID",
"middle_name": "ALEXANDER",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-11",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "dbullocksw@gmail.com",
"affiliation": "N",
"endpointDescription": "work email",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "17320 W 12 Mile Rd Ste 101",
"city": "Southfield",
"state": "MI",
"country_code": "US",
"postal_code": "480762102",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.