Individual provider Active NPI

Eric D Bullock, M.D.

  • Hospitalist Physician
  • Rockford, IL
National Provider Identifier
1417067695
Registry record updated Dec 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
036-104034 Issued in IL
Practice address
2400 N Rockton Ave
Rockford, IL 61103-3655
Phone
(815) 971-5000
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 036-104034 IL Primary

Addresses

Primary practice location

2400 N Rockton Ave
Rockford, IL 61103-3655

Mailing address

2400 N. Rockton Ave
Rockford, IL 61103-3655
Phone (815) 971-5000

Other identifiers 1

IdentifierTypeStateIssuer
036104034MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20100621000462 IL Practitioner - HospitalistPractitioner - Internal Medicine 6800927799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Washington University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians

Practice addresses (Care Compare)

2300 N Rockton Ave
Rockford, IL 61103-3619
Phone (815) 971-2000

8201 E Riverside Blvd
Rockford, IL 61114-2300
Phone (815) 971-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-104034ILMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Oct 1, 2001 Accepting new patients
RMH Pathologists, LTD Current Accepting new patients

Locations

Carol Stream, IL 60122

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

Interoperability endpoints

  • Direct secure messaging: ebullock51896@direct.mhemail.org

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261440000000",
    "number": "1417067695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 N. ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N ROCKTON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033655",
            "telephone_number": "815-971-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "ERIC",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036-104034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104034",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.