Individual provider Active NPI

Timothy Robert Bullion, D.D.S.

  • Dentist
  • Milwaukee, WI
National Provider Identifier
1295888303
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4389 Issued in WI
Practice address
161 W Wisconsin Ave
Suite 5035
Milwaukee, WI 53203-2602
Phone
(414) 273-5553
NPI assigned
Jan 19, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4389 WI Primary

Addresses

Primary practice location

161 W Wisconsin Ave
Suite 5035
Milwaukee, WI 53203-2602

Mailing address

161 W Wisconsin Ave
Suite 5035
Milwaukee, WI 53203-2602
Phone (414) 273-5553

Other identifiers 1

IdentifierTypeStateIssuer
33707000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160519001467 WI Order and Referring Only - DentistPractitioner - Dentist 4688963382

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4389WIMDDentist

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295888303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 W WISCONSIN AVE",
            "address_2": "SUITE 5035",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032602",
            "telephone_number": "414-273-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 W WISCONSIN AVE",
            "address_2": "SUITE 5035",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032602",
            "telephone_number": "414-273-5553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLION",
        "first_name": "TIMOTHY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "4389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33707000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.