Active NPI
Oliver C. Bullock, DO
- Family Medicine Physician
- Philadelphia, PA
National Provider Identifier
1184625865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS004271L
- Practice address
- 2100 W Cambria St
Philadelphia, PA 19132-2632 - Phone
- (215) 578-3300
- Fax
- (215) 578-3335
- NPI assigned
- Aug 3, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS004271L | PA | Primary |
Addresses
Primary practice location
2100 W Cambria St
Philadelphia, PA 19132-2632
Mailing address
2100 W Cambria St
Philadelphia, PA 19132-2632
Phone (215) 578-3300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000655010 | Medicaid | PA |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS004271L | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Philadelphia College of Osteopathic Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Organizations & group practices 1
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.
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- Philadelphia, PA
- NPI 1316230220
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239148800000",
"number": "1184625865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 W CAMBRIA ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191322632",
"telephone_number": "215-578-3300",
"fax_number": "215-578-3335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 W CAMBRIA ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191322632",
"telephone_number": "215-578-3300",
"fax_number": "215-578-3335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "OLIVER",
"middle_name": "C.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2009-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS004271L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000655010",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.