Kelly Bultman

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.006573RX Issued in OH

Practice address

2510 Commons Blvd Ste 210
Beavercreek, OH 45431-3821

Phone

(513) 833-4912

NPI assigned

May 20, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Qualified Emergency Specialists Inc

  • Emergency Medicine Physician
  • Cincinnati, OH
  • NPI 1700872728
  Medicare reassignment

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1104491414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 COMMONS BLVD STE 210",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454313821",
            "telephone_number": "513-833-4912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 COMMONS BLVD STE 210",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454313821",
            "telephone_number": "513-833-4912"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4956 Jessica Suzanne Dr",
            "address_purpose": "LOCATION",
            "city": "Morrow",
            "state": "OH",
            "postal_code": "451528056",
            "country_code": "US",
            "telephone_number": "513-833-4912",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULTMAN",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-20",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006573RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Buckeye Behavior Services, LLC.
• Buckeye Behavioral Consulting Inc
• Nicole Buckingham, APRN-CNP
• Christopher A Buckner, MPT
• Lan-Anh Bui, D.D.S.
• Hannah Bundy, OTR/L
• April Anne Bunn, M.D.
• Amanda Buresh
• Rick J Burger, DDS
• Stephen P. Burke, D.D.S.

• Physician Assistant in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.