Jamal Morrisette Bullocks, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

M5077 Issued in TX

Practice address

2813 WTC Jester Blvd
Houston, TX 77018-7004

Phone

(713) 715-7083

Fax

(866) 224-6704

NPI assigned

Mar 30, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Kelsey-Seybold Medical Group, PLLC

  dba Kelsey Seybold Clinic

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1013915255
  Medicare reassignment NPD
• Baylor College of Medicine

  • Plastic Surgery Physician
  • Houston, TX
  • NPI 1730114125
  NPD (past)

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1134249451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2813 WTC JESTER BLVD.",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770187004",
            "telephone_number": "713-715-7083",
            "fax_number": "866-224-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2813 WTC JESTER BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770187004",
            "telephone_number": "713-715-7083",
            "fax_number": "866-224-6704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCKS",
        "first_name": "JAMAL",
        "middle_name": "MORRISETTE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "M5077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189667206",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189667208",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189667207",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Bullock, M.S. CCC-SLP
• Karona Michelle Bullock, CCC-SLP
• Nyasha Onika Bullock, M.D.
• Zoe Bullock
• Bullocks Plastic Surgery, P.L.L.C.
• Lysah Miriam Bulonza
• Alessia Bulsara, LPC
• Isabela Marie Bumanlag
• Erin Bumbera, M.S., BCBA
• Erika Bumgardner

• Plastic and Reconstructive Surgery Physician in Houston, TX
• Providers in Houston, TX by specialty
• Plastic and Reconstructive Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; 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.