Christopher J Bullard, MD
Individual provider Active NPI Internal Medicine Physician · Moscow, ID
NPI 1306379052 · NPPES record last updated Jul 19, 2024
Key facts
- NPI
- 1306379052
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- M-15235 (ID)
- Practice address
- 719 S Main St
Moscow, ID 83843-3041 - Phone
- (208) 883-1152
- Fax
- (208) 882-1486
- NPI assigned
- Apr 10, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gritman Medical Center Inc
Gritman Medical Center Inc
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
- Centerwell Home Health
- Elite Home Health
- Gritman Medical Center
- Pullman Regional Hospital
- St Joseph Regional Medical Center
- Aspen Park of Cascadia
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210921001203 | ID | Practitioner - Internal Medicine | 4385912294 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-15235 | ID | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gritman Medical Center Inc | Current | Accepting new patients | |
| Gritman Medical Center Inc | Current |
Accepting new patients | |
| Gritman Medical Center Inc | Current |
Accepting new patients | |
| Gritman Medical Center Inc. | Current |
Accepting new patients | |
| Gritman Medical Center Inc | Current |
Accepting new patients | |
| Gritman Medical Center, Inc. | Past | Accepting new patients | |
| Gritman Medical Center Inc | Internal Medicine | Past | Accepting new patients |
Locations
719 S Main St
Moscow, ID 83843
Phone (208) 848-8300
700 S Main St
Moscow, ID 83843
Phone (208) 746-7555
Interoperability endpoints
- cbullard689715@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | M-15235 | ID | Yes |
| 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
Other providers in Moscow, ID
- John Barclay Brown III
- Samantha Brownell
- Pamela Jean Bruce
- Michelle Brunke
- Laura Buchanan
- McKenna Kieley Burcham
- Kimi L Burkle
- Amanda Burks
- Olivia Buzo
- C and R Inc.
All providers in Moscow, ID · Internal Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.