NPIMap

Individual provider Active NPI

Tanner R. Bulkley, PA-C

  • Physician Assistant
  • Troy, PA
National Provider Identifier
1104336742
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA059314 Issued in PA
Practice address
45 Mud Creek Rd
Troy, PA 16947-9529
Phone
(570) 297-3746
NPI assigned
Oct 10, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA059314 PA Primary

Addresses

Primary practice location

45 Mud Creek Rd
Troy, PA 16947-9529

Mailing address

40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1945

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address upmchospitals@upmcdirect.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20171121000333 PA Practitioner - Physician Assistant 7113284589 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Guthrie Medical Group PCGroup PAC ID 6002728656, 795 clinicians

Practice addresses (Care Compare)

1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858

275 Guthrie Dr
Troy, PA 16947-8115
Phone (570) 297-2121

285 Guthrie Dr
Troy, PA 16947-8115
Phone (570) 297-4104

37 Pratt Ave
Towanda, PA 18848-9702
Phone (570) 268-4713

91 Hospital Dr
Towanda, PA 18848-9702
Phone (570) 265-6164

One Guthrie SQ
Sayre, PA 18840-1625

One Guthrie Square
Sayre, PA 18840-1625

Hospital & facility affiliations

  • Troy Community Hospital Hospital, Troy, PA, CCN 391305
  • Robert Packer Hospital Hospital, Sayre, PA, CCN 390079
  • Troy Community Hospital Nursing home, CCN 39Z305

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Penn Comprehensive Health Services CurrentSince Jul 17, 2023 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Jul 1, 2024 Accepting new patients
North Penn Comprehensive Health Services CurrentSince Jul 17, 2023 Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 23, 2017 Accepting new patients
Lehigh Valley Physician Group CurrentSince Oct 23, 2017 Accepting new patients
Guthrie Medical Group, P.C. CurrentSince Jul 1, 2024 Accepting new patients
Robert Packer Hospital Past Accepting new patients
Troy Community Hospital Incorporated Past Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

1200 S Cedar Crest Blvd
Allentown, PA 18103
Phone (484) 862-3200

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

40 W Wellsboro St
Mansfield, PA 16933
Phone (570) 662-1945

1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106

45 Mud Creek Rd
Troy, PA 16947
Phone (570) 297-3746

275 Guthrie Dr
Troy, PA 16947
Phone (570) 297-2121

7 Water St
Wellsboro, PA 16901
Phone (570) 724-1010

Interoperability endpoints

  • Direct secure messaging: tbulkley196098@direct-guthrie.org

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 and National Provider Directory roles.

View all 14

Hospital & facility affiliations 5

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": "1507593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1104336742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 MUD CREEK RD",
            "city": "TROY",
            "state": "PA",
            "postal_code": "169479529",
            "telephone_number": "570-297-3746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULKLEY",
        "first_name": "TANNER",
        "middle_name": "R.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-10",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA059314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "upmchospitals@upmcdirect.com",
            "affiliation": "N",
            "endpointDescription": "UPMC direct address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "600 Grant St Fl 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Troy, PA

Sources for this page

Verify at the official NPI Registry.