Active NPI
Gregory Bullis, M.D.
- Emergency Medical Services (Emergency Medicine) Physician
- Rockford, IL
National Provider Identifier
1497784797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- License
- 036067306
- Practice address
- 5666 East State St
Rockford, IL 61108-2472 - Phone
- (815) 226-2000
- Fax
- (815) 381-7582
- NPI assigned
- Jul 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 036067306 | IL | Primary |
Addresses
Primary practice location
5666 East State St
Rockford, IL 61108-2472
Mailing address
5666 East State St
Rockford, IL 61108-2472
Phone (815) 226-2000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36067306 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036067306 | IL | MD | Emergency Medical Services (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383264000000",
"number": "1497784797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5666 EAST STATE ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082472",
"telephone_number": "815-226-2000",
"fax_number": "815-381-7582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5666 EAST STATE ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082472",
"telephone_number": "815-226-2000",
"fax_number": "815-381-7582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLIS",
"first_name": "GREGORY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-01",
"last_updated": "2013-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "IL",
"license": "036067306",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36067306",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.