NPIMap

Individual provider Active NPI

Bruce D Bullock, MD

  • Family Medicine Physician
  • Rutland, VT
National Provider Identifier
1649250358
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0420008555 Issued in VT
Practice address
8 Commons St
Rutland, VT 05701-4651
Phone
(802) 770-1805
Fax
(802) 773-4876
NPI assigned
Jan 19, 2006
Last updated
Mar 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0420008555 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

IdentifierTypeStateIssuer
OVN0388MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040702001278 VT Practitioner - Family Practice 5496732745 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Temple University School of Medicine, 1986
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Marble Valley Healthworks LLCGroup PAC ID 2264778638, 2 clinicians

Practice addresses (Care Compare)

8 Commons St
Rutland, VT 05701-4651

9 Commons St
Rutland, VT 05701-4651

9 Commons St
Rutland, VT 05701-4652
Phone (802) 779-4321

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0420008555VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
True Care Vermont, LLC Family Medicine CurrentSince Mar 7, 2022 Accepting new patients
Marble Valley Healthworks, LLC Family Medicine CurrentSince Feb 11, 2019 Accepting new patients

Locations

8 Commons St
Rutland, VT 05701
Phone (802) 770-1805

9 Commons St
Rutland, VT 05701
Phone (802) 779-4321

Interoperability endpoints

  • Direct secure messaging: bruce.bullock@4219.securemail.prognocis.com
  • Direct secure messaging: brucebullockmd@mvhw.medentdirect.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/zA015PZlU6y4mS2M66rhwFskWFFyp2EA/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1649250358",
    "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": {
        "last_name": "BULLOCK",
        "first_name": "BRUCE",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "0420008555",
            "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

Verify at the official NPI Registry.