NPIMap

Individual provider Active NPI

Christopher J Bullard, MD

  • Internal Medicine Physician
  • Moscow, ID
National Provider Identifier
1306379052
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M-15235 Issued in ID
Practice address
719 S Main St
Moscow, ID 83843-3041
Phone
(208) 883-1152
Fax
(208) 882-1486
NPI assigned
Apr 10, 2017
Last updated
Jul 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M-15235 ID Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

719 S Main St
Moscow, ID 83843-3041

Mailing address

PO Box 8007
Moscow, ID 83843-0507
Phone (208) 882-4511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210921001203 ID Practitioner - Internal Medicine 4385912294 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gritman Medical Center IncGroup PAC ID 8729070164, 15 clinicians
Gritman Medical Center IncGroup PAC ID 4981984390, 19 clinicians

Practice addresses (Care Compare)

700 S Main St
Moscow, ID 83843-3056
Phone (208) 882-4511

719 S Main St
Moscow, ID 83843-3041
Phone (208) 883-6779

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-15235IDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gritman Medical Center Inc Current Accepting new patients
Gritman Medical Center Inc CurrentSince Oct 1, 2021 Accepting new patients
Gritman Medical Center Inc CurrentSince Sep 1, 2021 Accepting new patients
Gritman Medical Center Inc. CurrentSince Sep 1, 2021 Accepting new patients
Gritman Medical Center Inc CurrentSince Oct 1, 2021 Accepting new patients
Gritman Medical Center Inc Internal Medicine Past Accepting new patients
Gritman Medical Center, Inc. Past Accepting new patients

Locations

700 S Main St
Moscow, ID 83843
Phone (208) 746-7555

719 S Main St
Moscow, ID 83843
Phone (208) 848-8300

Interoperability endpoints

  • Direct secure messaging: cbullard689715@direct.ochin.org

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1306379052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8007",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838430507",
            "telephone_number": "208-882-4511",
            "fax_number": "208-883-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 S MAIN ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433041",
            "telephone_number": "208-883-1152",
            "fax_number": "208-882-1486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "CHRISTOPHER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-10",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M-15235",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

Verify at the official NPI Registry.