Active NPI
Bruce D Bullock, MD PC
- Family Medicine Physician
- Rutland, VT
National Provider Identifier
1497271886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 042.0008555
- Legal business name
- BRUCE D BULLOCK, MD PC
- Practice address
- 8 Commons St
Rutland, VT 05701-4651 - Phone
- (802) 770-1805
- Fax
- (802) 773-4876
- NPI assigned
- Aug 17, 2017
- Organization subpart
- Yes
- Parent organization
- BRUCE D BULLOCK, MD PC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Ann M Hughes
- Title
- Practice Manager
- Phone
- (802) 772-1989
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 042.0008555 | VT | Primary |
Addresses
Primary practice location
8 Commons St
Rutland, VT 05701-4651
Mailing address
8 Commons St
Rutland, VT 05701-4651
Phone (802) 770-1805
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OVN0388 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170901002530 | VT | Part B Supplier - Clinic/Group Practice | 8628341245 |
Receives reassigned benefits from 1 practitioner Practice locations: Rutland, VT |
National Provider Directory
National Provider Directory- Part of
- Bruce D Bullock MD PC
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Rutland, VT
- NPI 1619955069
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502928000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1679961600000",
"number": "1497271886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 COMMONS ST",
"city": "RUTLAND",
"state": "VT",
"postal_code": "057014651",
"telephone_number": "802-770-1805",
"fax_number": "802-773-4876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 COMMONS ST",
"city": "RUTLAND",
"state": "VT",
"postal_code": "057014651",
"telephone_number": "802-770-1805",
"fax_number": "802-773-4876"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRUCE D BULLOCK, MD PC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BRUCE D BULLOCK, MD PC",
"enumeration_date": "2017-08-17",
"last_updated": "2023-03-28",
"certification_date": "2023-03-28",
"status": "A",
"authorized_official_last_name": "HUGHES",
"authorized_official_first_name": "ANN",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "PRACTICE MANAGER",
"authorized_official_telephone_number": "802-772-1989",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "VT",
"license": "042.0008555",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OVN0388",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rutland, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.