Individual provider Active NPI

Graham Wesley Bullard, MD

  • Pain Medicine (Anesthesiology) Physician
  • Winston Salem, NC
National Provider Identifier
1861480469
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
26624 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-5812
Phone
(336) 716-2255
NPI assigned
Oct 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 26624 NC
Pain Medicine (Anesthesiology) Physician 207LP2900X 26624 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-5812

Mailing address

PO Box 36351
Southeast Anesthesiology Consultants PA
Charlotte, NC 28236-6351
Phone (704) 377-5772

Other practice location 1

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2372

Other identifiers 2

IdentifierTypeStateIssuer
8919726MedicaidNC
N26624MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 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

Enrollment IDStateProvider typePAC IDDetails
I20080311000020 SC Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 5698850030 Reassigns benefits to 1 organization
I20090318000725 NC Practitioner - AnesthesiologyPractitioner - Interventional Pain ManagementPractitioner - Pain Management 5698850030 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Interventional Pain Management, Pain Management
Education
University of North Carolina at Chapel Hill School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

  • Lexington Memorial Hospital Inc Hospital, Lexington, NC, CCN 340096
  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Sep 1, 2011 Accepting new patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology CurrentSince Sep 1, 1987 Accepting new patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology CurrentSince Sep 1, 1987 Accepting new patients
CHS Anesthesia Services Group Inc Anesthesiology CurrentSince Dec 15, 2015 Accepting new patients
Wake Forest University Health Sciences CurrentSince Sep 1, 2018 Accepting new patients
Anesthesiology Consultants of South Carolina, PLLC Anesthesiology Past Accepting new patients
Southeast Pain & Spine Care Specialists, LLC PastSince Dec 22, 2024 Accepting new patients
Southeast Pain Management Services, PLLC Pain Medicine Past Accepting new patients

Locations

927 East Blvd
Charlotte, NC 28203
Phone (704) 348-1855

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

16455 Statesville Rd
Ste 100
Huntersville, NC 28078
Phone (704) 801-1701

16455 Statesville Rd
Huntersville, NC 28078
Phone (704) 801-3719

10 Medical Park Dr
Ste 1
Lexington, NC 27292
Phone (336) 238-4077

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616
Phone (919) 882-0705

2520 Independence Blvd
Ste 200
Wilmington, NC 28412
Phone (910) 442-1100

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

118 Professional Park Dr
Rock Hill, SC 29732
Phone (803) 329-3124

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CDEHDD
  • Direct secure messaging: gbullard2753072@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 8

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.

Hospital & facility affiliations 6

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": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1861480469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36351",
            "address_2": "SOUTHEAST ANESTHESIOLOGY CONSULTANTS PA",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282366351",
            "telephone_number": "704-377-5772",
            "fax_number": "704-377-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271575812",
            "telephone_number": "336-716-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Blythe Blvd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282035812",
            "country_code": "US",
            "telephone_number": "704-355-2372",
            "fax_number": "704-355-6692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "GRAHAM",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "26624",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NC",
            "license": "26624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8919726",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N26624",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.