NPIMap

Individual provider Active NPI

Samuel William Bullick, D.O.

  • Pulmonary Disease Physician
  • Portland, OR
National Provider Identifier
1386904662
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
DO188659 Issued in OR
Practice address
1015 NW 22ND Ave
Portland, OR 97210-3025
Phone
(503) 413-8407
Fax
(503) 413-6951
NPI assigned
May 21, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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 LL158520 OR
Pulmonary Disease Physician 207RP1001X DO188659 OR Primary

Addresses

Primary practice location

1015 NW 22ND Ave
Portland, OR 97210-3025

Mailing address

PO Box 3777
Portland, OR 97208-3777
Phone (503) 413-3900

Other practice location 1

4150 V St Ste 3400
Sacramento, CA 95817-1460
Phone (916) 734-4597

Other practice location 2

4150 V St Ste 3400
Sacramento, CA 95817-1460
Phone (916) 734-4597

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20181022002155 OR Practitioner - Pulmonary Disease 2860633286 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

Hospital & facility affiliations

  • Legacy Good Samaritan Medical Center Hospital, Portland, OR, CCN 380017
  • Legacy Emanuel Medical Center Hospital, Portland, OR, CCN 380007
  • Legacy Mount Hood Medical Center Hospital, Gresham, OR, CCN 380025

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13895CAMDAcupuncturist
LL158520ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Mount Hood Medical Center Current Accepting new patients
Legacy Clinics LLC CurrentSince Aug 27, 2018 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Oct 31, 2018 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Oct 31, 2018 Accepting new patients
Legacy Mount Hood Medical Center CurrentSince Oct 31, 2018 Accepting new patients
Legacy Meridian Park Hospital CurrentSince Oct 31, 2018 Accepting new patients
Silverton Health CurrentSince May 1, 2019 Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Aug 27, 2018 Accepting new patients
Silverton Health Current Accepting new patients
Silverton Health CurrentSince May 1, 2019 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Oct 31, 2018 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Oct 31, 2018 Accepting new patients
Legacy Meridian Park Hospital Past Accepting new patients
Legacy Salmon Creek Hospital Past Accepting new patients

Locations

24800 SE Stark St
Gresham, OR 97030
Phone (503) 413-8407

1130 NW 22nd Ave
Ste 400
Portland, OR 97210
Phone (503) 413-6555

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660

19300 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-1212

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 7

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": "1337558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1386904662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3777",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083777",
            "telephone_number": "503-413-3900",
            "fax_number": "503-413-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-8407",
            "fax_number": "503-413-6951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4150 V St Ste 3400",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958171460",
            "country_code": "US",
            "telephone_number": "916-734-4597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4150 V St Ste 3400",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958171460",
            "country_code": "US",
            "telephone_number": "916-734-4597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLICK",
        "first_name": "SAMUEL",
        "middle_name": "WILLIAM",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-21",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "LL158520",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OR",
            "license": "DO188659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.