Active NPI
Tyler Bullard-Wolf
- Pediatrics Physician
- Austin, TX
National Provider Identifier
1245079607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- BP10088328
- Practice address
- 4900 Mueller Blvd Ste 3J018
Austin, TX 78723-3051 - Phone
- (512) 495-5555
- NPI assigned
- May 23, 2024
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | BP10088328 | TX | Primary |
Addresses
Primary practice location
4900 Mueller Blvd Ste 3J018
Austin, TX 78723-3051
Mailing address
Dell Medical School Gme Office
1501 Red River Street, 2ND Floor
Austin, TX 78729
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240604004435 | TX | Order and Referring Only - Pediatric Medicine | 3072055193 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BP10088328 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716422400000",
"number": "1245079607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DELL MEDICAL SCHOOL GME OFFICE",
"address_2": "1501 RED RIVER STREET, 2ND FLOOR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4900 MUELLER BLVD STE 3J018",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787233051",
"telephone_number": "512-495-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLARD-WOLF",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "U",
"enumeration_date": "2024-05-23",
"last_updated": "2024-05-23",
"certification_date": "2024-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "BP10088328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; 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.