Individual provider Active NPI

Dawn E Bull, NP

  • Nurse Practitioner
  • Worcester, MA
National Provider Identifier
1891941167
Registry record updated May 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
212662 Issued in MA
Practice address
55 Lake Ave N
Worcester, MA 01655-0002
Phone
(508) 334-3278
Fax
(508) 334-7284
NPI assigned
Aug 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 212662 MA Primary

Addresses

Primary practice location

55 Lake Ave N
Worcester, MA 01655-0002

Mailing address

PO Box 415348
Boston, MA 02241-0001
Phone (800) 225-8885

Other identifiers 1

IdentifierTypeStateIssuer
110080857AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081117000174 MA Practitioner - Nurse Practitioner 9638239908 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
212662MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Umass Memorial Medical Center, Inc CurrentSince Sep 3, 2023 Accepting new patients
Umass Memorial Medical Center, Inc. CurrentSince Sep 3, 2023 Accepting new patients
Umass Memorial Medical Center, Inc. Current Accepting new patients

Locations

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

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": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556668800000",
    "number": "1891941167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415348",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022410001",
            "telephone_number": "800-225-8885",
            "fax_number": "508-334-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LAKE AVE N",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016550002",
            "telephone_number": "508-334-3278",
            "fax_number": "508-334-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULL",
        "first_name": "DAWN",
        "middle_name": "E",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2019-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "212662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110080857A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

Verify at the official NPI Registry.