Individual provider Active NPI

Jamie L Bullock, P.A.

  • Physician Assistant
  • Washington, DC
National Provider Identifier
1194956243
Registry record updated Dec 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110003049 Issued in VA
Practice address
900 23Rd St NW
Washington, DC 20037-2342
Phone
(202) 715-4000
Fax
(202) 715-4015
NPI assigned
Aug 6, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2022

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 0110003049 VA Primary

Addresses

Primary practice location

900 23Rd St NW
Washington, DC 20037-2342

Mailing address

20010 Century Blvd.
Suite 200
Germantown, MD 20874-1106
Phone (240) 686-2300

Other practice location 1

4320 Seminary Rd
Alexandria, VA 22304-1535
Phone (703) 504-3066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20091030000467 DC Practitioner - Physician Assistant 6608913280 Reassigns benefits to 3 organizations
I20091104000127 VA Practitioner - Physician Assistant 6608913280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inova Health Care ServicesGroup PAC ID 2466351093, 1,821 clinicians

Practice addresses (Care Compare)

2501 Parkers LN
Alexandria, VA 22306-3209
Phone (877) 511-4625

3300 Gallows Rd
Falls Church, VA 22042-3307

4320 Seminary Rd
Alexandria, VA 22304-1535

Hospital & facility affiliations

  • Inova Alexandria Hospital Hospital, Alexandria, VA, CCN 490040

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110003049VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
District Hospital Partners L P CurrentSince Apr 23, 2019 Accepting new patients
Inova Health Care Services CurrentSince Aug 28, 2023 Accepting new patients
Inova Health Care Services CurrentSince Aug 28, 2023 Accepting new patients
District Hospital Partners LP CurrentSince Apr 23, 2019 Accepting new patients
Inova Health Care Services CurrentSince Aug 28, 2023 Accepting new patients
Alexandria Springfield Emergency Physicians PC Past Accepting new patients
Emergency Medicine Associates P.a., P.C. Past Accepting new patients

Locations

900 23rd St NW
Washington, DC 20037
Phone (202) 715-4750

4320 Seminary Rd
Alexandria, VA 22304
Phone (703) 504-3000

1701 N George Mason Dr
Arlington, VA 22205
Phone (703) 558-5000

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

15225 Heathcote Blvd
Haymarket, VA 20169
Phone (571) 284-1000

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

Organizations & group practices 8

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.

Hospital & facility affiliations 1

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": "1249516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670112000000",
    "number": "1194956243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20010 CENTURY BLVD.",
            "address_2": "SUITE 200",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208741106",
            "telephone_number": "240-686-2300",
            "fax_number": "240-686-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 23RD ST NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200372342",
            "telephone_number": "202-715-4000",
            "fax_number": "202-715-4015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4320 Seminary Rd",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223041535",
            "country_code": "US",
            "telephone_number": "703-504-3066",
            "fax_number": "703-504-3086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "JAMIE",
        "middle_name": "L",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-06",
        "last_updated": "2022-12-04",
        "certification_date": "2022-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110003049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.