Active NPI
WM John Bullis, MD
- Gynecology Physician
- Clyde Hill, WA
National Provider Identifier
1063473841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 60033065
- Practice address
- 8610 NE 17TH St
Clyde Hill, WA 98004-3241 - Phone
- (509) 720-0691
- NPI assigned
- Mar 31, 2006
- Last updated
- Jul 21, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 60033065 | WA | Primary |
| Gynecology Physician | 207VG0400X | M-10613 | ID |
Addresses
Primary practice location
8610 NE 17TH St
Clyde Hill, WA 98004-3241
Mailing address
8610 NE 17TH St
Clyde Hill, WA 98004-3241
Phone (509) 720-0691
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9663436 | Other | GHI | |
| 86806 | Other | MEDCOST | |
| 11941 | Other | BLUE CROSS BLUE SHIELD | |
| 160051634 | Other | MEDICARE RAILROAD | |
| FH1000860 | Other | FIRST CAROLINA CARE | |
| N0044A | Medicaid | SC | |
| 8911941 | Medicaid | NC |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-10613 | ID | MD | Gynecology Physician |
| 60033065 | WA | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1063473841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8610 NE 17TH ST",
"city": "CLYDE HILL",
"state": "WA",
"postal_code": "980043241",
"telephone_number": "509-720-0691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8610 NE 17TH ST",
"city": "CLYDE HILL",
"state": "WA",
"postal_code": "980043241",
"telephone_number": "509-720-0691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLIS",
"first_name": "WM",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2011-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "WA",
"license": "60033065",
"primary": true
},
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "ID",
"license": "M-10613",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "9663436",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "86806",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "11941",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "160051634",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST CAROLINA CARE",
"identifier": "FH1000860",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N0044A",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8911941",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clyde Hill, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.