Lucilyn Ann Bullock, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

50-000779 Issued in OH

Practice address

60 North Ave
Tallmadge, OH 44278-2011

Phone

(330) 670-4242

Fax

(330) 670-4241

NPI assigned

Feb 1, 2007

Last updated

Mar 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BBBCAA
• Direct secure messaging: lbullock22144@summahealth-direct.org

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.

• Pioneer Physicians Network, Inc.

  • Family Medicine Physician
  • Uniontown, OH
  • NPI 1851354633
  Medicare reassignment NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  OH

  Medicare reassignment
• Pioneer Physicians Network Inc

  • Family Medicine Physician
  • Canton, OH
  • NPI 1174296172
  NPD
• Crystal Clinic, Inc.

  • Orthopaedic Surgery Physician
  • Akron, OH
  • NPI 1619906914
  NPD (past)

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1104963552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 NORTH AVE",
            "city": "TALLMADGE",
            "state": "OH",
            "postal_code": "442782011",
            "telephone_number": "330-630-9726",
            "fax_number": "330-634-2194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 NORTH AVE",
            "city": "TALLMADGE",
            "state": "OH",
            "postal_code": "442782011",
            "telephone_number": "330-670-4242",
            "fax_number": "330-670-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "LUCILYN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "50-000779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Brotman Domoracki, AU.D.
• Amihya Brown
• Anihya Brown
• Maggie M Brown
• Leah Buck
• Jason M Bursach
• Katelin Marie Byerly
• Humberto Gonzales Caballero
• Amy Eda Cakir
• Michael Adam Carder

• Medical Physician Assistant in Tallmadge, OH
• Providers in Tallmadge, OH by specialty
• Medical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 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.