NPIMap

Organization Active NPI

Neal M Bullock DPM PA

  • Podiatrist
  • Pembroke Pines, FL
National Provider Identifier
1598935249
Registry record updated May 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO2571 Issued in FL
Legal business name
NEAL M BULLOCK DPM PA
Practice address
17013 Pines Blvd
Pembroke Pines, FL 33027-1003
Phone
(954) 450-4200
Fax
(954) 450-4237
NPI assigned
Mar 10, 2008
Last updated
May 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2011

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

Authorized official

Name
Dr. Neal M Bullock, DPMNPI 1902912793
Title
President Owner
Phone
(954) 450-4200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X FL
Podiatrist 213E00000X PO2571 FL Primary

Addresses

Primary practice location

17013 Pines Blvd
Pembroke Pines, FL 33027-1003

Mailing address

17013 Pines Blvd
Pembroke Pines, FL 33027-1003
Phone (954) 450-4200

Other identifiers 1

IdentifierTypeStateIssuer
390394000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110602000121 FL Part B Supplier - Clinic/Group Practice 5890972723 Receives reassigned benefits from 5 practitioners
Practice locations: Pembroke Pines, FL; Hollywood, FL
O20130430000597 FL DME Supplier - Physician - Podiatry 5890972723 Practice locations: Pembroke Pines, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2177228Neal M Bullock DPM PA17013 Pines Blvd, Room #2, Pembroke Pines, FL 33027ComplianceMay 18, 2028

National Provider Directory

National Provider Directory

Locations

17013 Pines Blvd
Pembroke Pines, FL 33027
Phone (954) 450-4200

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1205107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305849600000",
    "number": "1598935249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17013 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271003",
            "telephone_number": "954-450-4200",
            "fax_number": "954-450-4237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17013 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271003",
            "telephone_number": "954-450-4200",
            "fax_number": "954-450-4237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEAL M BULLOCK DPM PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-10",
        "last_updated": "2011-05-20",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "NEAL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "954-450-4200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO2571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390394000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.