Active NPI
Lenora Y Bullock, MD
- Emergency Medicine Physician
- Washington, DC
National Provider Identifier
1790718286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- MD32830
- Practice address
- 1150 Varnum St NE
Washington, DC 20017 - Phone
- (202) 269-7000
- NPI assigned
- Jul 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | MD32830 | DC | Primary |
Addresses
Primary practice location
1150 Varnum St NE
Washington, DC 20017
Mailing address
2100 Powell St
Ste 900
Emeryville, CA 94608-1844
Phone (510) 851-7423
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110308000999 | GA | Practitioner - Emergency Medicine | 7214119569 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 93.93 of 100
- Quality
- 82.14
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD32830 | DC | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peachtree Immediate Care FP, LLC | Current | Accepting new patients | |
| The Bortolazzo Group, LLC | Emergency Medicine | Current | Accepting new patients |
| Providence Health Services, Inc | Past | Accepting new patients |
Locations
3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752
590 Lanier Ave W
Fayetteville, GA 30214
1275 Highway 54 W
Ste 201
Fayetteville, GA 30214
Phone (770) 461-3776
3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900
Interoperability endpoints
- https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
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 and National Provider Directory roles.
-
- Emergency Medicine Physician
- Austell, GA
- NPI 1801965082
Emergency Medicine, GA
-
- Anesthesiology Physician
- Washington, DC
- NPI 1740795293
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487808000000",
"number": "1790718286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 POWELL ST",
"address_2": "STE 900",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081844",
"telephone_number": "510-851-7423",
"fax_number": "510-879-9120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1150 VARNUM ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "20017",
"telephone_number": "202-269-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "LENORA",
"middle_name": "Y",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-08",
"last_updated": "2017-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "DC",
"license": "MD32830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; 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.