Active NPI
Rebecca L Bultman, MD
- Pediatrics Physician
- Grand Rapids, MI
National Provider Identifier
1972574309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4301065600
- Practice address
- 100 Michigan St NE
Room 280
Grand Rapids, MI 49503-2560 - Phone
- (616) 391-5275
- Fax
- (616) 391-8848
- NPI assigned
- Feb 1, 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301065600 | MI | Primary |
Addresses
Primary practice location
100 Michigan St NE
Room 280
Grand Rapids, MI 49503-2560
Mailing address
100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558407189 | Other | MI | GROUP NPI |
| 0410823 | Other | MI | BCBSM |
| 3516825 | Medicaid | MI |
Other names 1
- Rebecca Lynn Bos
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- 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 |
|---|---|---|---|---|
| I20051027000181 | MI | Practitioner - Pediatric Medicine | 9537186713 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752796800000",
"number": "1972574309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MICHIGAN ST NE",
"address_2": "MC 845",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MICHIGAN ST NE",
"address_2": "ROOM 280",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032560",
"telephone_number": "616-391-5275",
"fax_number": "616-391-8848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULTMAN",
"first_name": "REBECCA",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-01",
"last_updated": "2025-07-18",
"certification_date": "2025-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301065600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP NPI",
"identifier": "1558407189",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "0410823",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3516825",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "REBECCA",
"last_name": "BOS",
"middle_name": "LYNN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.