Mark J Bult, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

R5G60 Issued in MO

Practice address

1155 W Parkview
Suite 1C
Bolivar, MO 65613-7800

Phone

(417) 326-7246

Fax

(417) 777-2968

NPI assigned

Feb 24, 2006

Last updated

Dec 14, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• CMH Institute for Pain Management

  • Pain Medicine (Anesthesiology) Physician
  • Bolivar, MO
  • NPI 1306995451
  Authorized official Same address or phone
• Ozark Anesthesia Associates, Inc.

  • Anesthesiology Physician
  • Springfield, MO
  • NPI 1831109586
  NPD (past)
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450051200000",
    "number": "1326014945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133011",
            "telephone_number": "417-326-6000",
            "fax_number": "417-328-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 W PARKVIEW",
            "address_2": "SUITE 1C",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656137800",
            "telephone_number": "417-326-7246",
            "fax_number": "417-777-2968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULT",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2015-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "R5G60",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garry J Brown, DO
• Ira Jason Brown, DPT
• Courtney Marie Brummel, MSN, FNP-C
• Susan Kay Buchen, SLP, CCC
• Samuel Christian Buesking, PHARMD
• Jennifer A Bushre, APRN, NP
• Leah M Cagle, OTR
• Robert Dale Cagle, D.O.
• Shannon Leigh Calvert, MD
• Ian Scott Campbell

• Specialist in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.