Richard J Bultman, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME017622 Issued in FL

Practice address

1594 Kingsley Ave
Orange Park, FL 32073-4546

Phone

(904) 264-8621

Fax

(904) 215-9418

NPI assigned

Jul 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Michigan Medical School, 1969

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Memorial Family Practice Associates, LLCGroup PAC ID 8820003411, 50 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.52 of 100Reported as group

Quality

78.57

Promoting interoperability

99

Improvement activities

40

Cost

74

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: richard.bultman.1@14441.direct.athenahealth.com
• Direct secure messaging: richard.bultman@hca5.eclinicaldirectplus.com

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.

• Memorial Family Practice Associates, LLC

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1598869844
  Medicare reassignment Care Compare group NPD
• Memorial Family Practice Associates LLC

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1851333108
  NPD (past)

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1316946189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1594 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734546",
            "telephone_number": "904-264-8621",
            "fax_number": "904-215-9418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1594 KINGSLEY AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734546",
            "telephone_number": "904-264-8621",
            "fax_number": "904-215-9418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULTMAN",
        "first_name": "RICHARD",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME017622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000458300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02009",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL LICENSE",
            "identifier": "ME017622",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "RICHARD.BULTMAN@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1594 Kingsley Ave",
            "city": "Orange Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320734546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carlyssa Shinelle Bucknor
• Charles Budzyn, DO
• Desiree Shantel Buggs
• Matthew Bull, PHARM.D.
• John Robert Bullock, MD
• Rex Burch, DO
• Cassia Burgess, RBT
• Alaina Jane Burke
• Kristen T Burke, D.C.
• Rachel Elizabeth Burke

• Family Medicine Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.