Travis L Bullock, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

036119508 Issued in IL

Practice address

12855 N 40 Dr Ste 350
Saint Louis, MO 63141-8669

Phone

(314) 567-6071

Fax

(314) 567-3321

NPI assigned

Feb 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Leslie Travis Bullock Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Urology

Education

Eastern Virginia Medical School, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Urology of St Louis IncGroup PAC ID 6204723786, 112 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Anderson Hospital Hospital, Maryville, IL, CCN 140289
• Missouri Baptist Medical Center Hospital, Saint Louis, MO, CCN 260108
• HSHS St Elizabeth'S Hospital Hospital, O Fallon, IL, CCN 140187
• HSHS Holy Family Hospital Inc Hospital, Greenville, IL, CCN 140137
• SSM Health Rehabilitation Hospital Inpatient rehabilitation facility, Richmond Heights, MO, CCN 263031

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: travisbullock@slus.allscriptsdirect.net
• Direct secure messaging: tbullock@yourcarecommunity.org

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.

• Urology of St. Louis, Inc.

  • Specialist
  • Saint Louis, MO
  • NPI 1528017191

  IL, Urology

  Medicare reassignment Care Compare group NPD
• Ahs Il Medical Group LLC

  • Clinic/Center
  • Granite City, IL
  • NPI 1659098101
  Medicare reassignment NPD
• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Urology of St. Louis, Inc.

  • Specialist
  • O Fallon, IL
  • NPI 1265392476
  NPD
• Urology of St. Louis, Inc.

  • Urology Physician
  • Fairview Heights, IL
  • NPI 1528901287
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Missouri Baptist Medical Center

  • General Acute Care Hospital
  • Saint Louis, MO
  • NPI 1487663506
  Care Compare affiliation
• SSM Select Rehab St Louis LLC

  • Rehabilitation Hospital
  • Richmond Heights, MO
  • NPI 1659511988

  Inpatient rehabilitation facility

  Care Compare affiliation
• Anderson Hospital

  • General Acute Care Hospital
  • Maryville, IL
  • NPI 1053481630
  Care Compare affiliation
• HSHS Holy Family Hospital Inc

  • General Acute Care Hospital
  • Greenville, IL
  • NPI 1205850690
  Care Compare affiliation
• St Elizabeths Hospital of the Hospital Sisters of the Third Order

  • General Acute Care Hospital
  • O Fallon, IL
  • NPI 1629057302
  Care Compare affiliation

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1699810507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12855 N. FORTY DR.",
            "address_2": "STE 375",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-567-6071",
            "fax_number": "314-567-3321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12855 N 40 DR STE 350",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418669",
            "telephone_number": "314-567-6071",
            "fax_number": "314-567-3321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Saint Lukes Center Dr Ste 40",
            "address_purpose": "LOCATION",
            "city": "Chesterfield",
            "state": "MO",
            "postal_code": "630173509",
            "country_code": "US",
            "telephone_number": "314-567-6071",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6812 State Route 162 Ste 200",
            "address_purpose": "LOCATION",
            "city": "Maryville",
            "state": "IL",
            "postal_code": "620628562",
            "country_code": "US",
            "telephone_number": "618-288-0900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "TRAVIS",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MO",
            "license": "2007030776",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036119508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "Y",
            "endpointDescription": "bjc",
            "affiliationName": "Missouri Baptist Medical Center",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12855 N. Forty Dr.",
            "address_2": "Ste 375",
            "city": "St. Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "63141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LESLIE",
            "last_name": "BULLOCK",
            "middle_name": "TRAVIS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Emilia Maria Bullard, DPT
• Angelica Bullay
• Susan P Bullington, CRNA
• Arnold Dewitt Bullock, MD
• Camille Rose Bullock
• Margaret Wawrzyniak Bultas, CPNP-PC
• Mary Elizabeth Bulte
• Andrea Bumb, NNP-BC
• Laura A. Bumberry, PSY.D.
• William M Bumberry, PH.D.

• Urology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Urology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.