Individual provider Active NPI

Patrick Tullis, PA-C

  • Physician Assistant
  • Lexington, KY
National Provider Identifier
1619374246
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1954 Issued in KY
Practice address
800 Rose St # Mn150
Lexington, KY 40536
Phone
(859) 323-0101
NPI assigned
Nov 25, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1954 KY
Surgical Physician Assistant 363AS0400X PA1954 KY
Physician Assistant 363A00000X PA1954 KY Primary

Addresses

Primary practice location

800 Rose St # Mn150
Lexington, KY 40536

Mailing address

800 Rose St # Mn150
Lexington, KY 40536-0293
Phone (618) 841-6282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150325002233 KY Practitioner - Physician Assistant 7618294901 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA1954KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Kentucky CurrentSince Jan 27, 2015 Accepting new patients

Locations

800 Rose St
#C101
Lexington, KY 40536

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

800 Rose St
#150
Lexington, KY 40536
Phone (859) 257-5548

Interoperability endpoints

  • Direct secure messaging: ptullis21973@ukhcdirect.org

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1619374246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ROSE ST # MN150",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405360293",
            "telephone_number": "618-841-6282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROSE ST # MN150",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "40536",
            "telephone_number": "859-323-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLIS",
        "first_name": "PATRICK",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-11-25",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA1954",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA1954",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.