Individual provider Active NPI

Lenora Y Bullock, MD

  • Emergency Medicine Physician
  • Washington, DC
National Provider Identifier
1790718286
Registry record updated Feb 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD32830 Issued in DC
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

Updated by the provider on Feb 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110308000999 GA Practitioner - Emergency Medicine 7214119569 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
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

LicenseStateTypeSpecialty
MD32830DCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peachtree Immediate Care FP, LLC CurrentSince Apr 6, 2024 Accepting new patients
The Bortolazzo Group, LLC Emergency Medicine CurrentSince Feb 1, 2011 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

  • FHIR API: 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.

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

Verify at the official NPI Registry.