Michael Brent Bulloch, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

94725281204 Issued in UT

Practice address

110 W 1325 N Ste 200
Cedar City, UT 84721-8179

Phone

(435) 586-7676

NPI assigned

Jun 22, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT, TX2 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

Family Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cedar Ridge Family Medicine 14 clinicians

Paiute Indian Tribe of Utah 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Zion'S Way Home Health Home health agency, St. George, UT, CCN 467243
• Intermountain Health Home Health - St. George Home health agency, St George, UT, CCN 467033
• Horizon Hospice Specialists - SG Hospice, St George, UT, CCN 461543
• Intermountain Health Cedar City Hospital Hospital, Cedar City, UT, CCN 460007
• St. George Regional Hospital Hospital, St George, UT, CCN 460021

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22054/brand/1/csg/1/fhir/r4
• Direct secure messaging: michael.bulloch.1@14860.direct.athenahealth.com
• Direct secure messaging: michael.bulloch.1@22054.direct.athenahealth.com

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.

• Cedar Ridge Family Medicine

  • Family Medicine Physician
  • Cedar City, UT
  • NPI 1740260504

  Family Medicine, UT

  Medicare reassignment Care Compare group NPD
• Paiute Indian Tribe of Utah

  • Clinic/Center
  • Cedar City, UT
  • NPI 1700062296

  TX

  Medicare reassignment Care Compare group NPD
• Paiute Indian Tribe of Utah

  • Clinic/Center
  • Richfield, UT
  • NPI 1336316975
  Care Compare group NPD
• Paiute Indian Tribe of Utah

  • Federally Qualified Health Center (FQHC)
  • St George, UT
  • NPI 1801063441
  Care Compare group NPD
• Paiute Indian Tribe of Utah

  • Clinic/Center
  • Kanosh, UT
  • NPI 1992972525
  Care Compare group NPD

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

• Hospice Specialists, LLC

  • Community Based Hospice Care Agency
  • St George, UT
  • NPI 1548450281

  Hospice

  Care Compare affiliation
• Ihc Health Services Inc

  • Home Health Agency
  • St George, UT
  • NPI 1932270246
  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • St George, UT
  • NPI 1366452880

  Hospital

  Care Compare affiliation
• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Cedar City, UT
  • NPI 1538178801

  Hospital

  Care Compare affiliation
• Red Rock Healthcare, Inc.

  • Home Health Agency
  • St George, UT
  • NPI 1588930705
  Care Compare affiliation

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

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1700149804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W 1325 N STE 200",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847218179",
            "telephone_number": "435-586-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W 1325 N STE 200",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847218179",
            "telephone_number": "435-586-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCH",
        "first_name": "MICHAEL",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-22",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "94725281204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700149804",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Sartini Buckner, LMFT
• John Curtis Buckner, LMFT
• Lily Bullen
• Matt Kevin Bulloch, L.P.C. NCC
• Micah J Bulloch, LCSW
• Clint O Bunker, DO
• Tani Dale Bunker
• Augustine Bunkley
• Brian N Burrows, MD
• David Lynn Butler, RPH

• All providers in Cedar City, UT
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; 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.