Dr Kelly Leigh Bullock, DO is a medicare enrolled "Family Medicine" physician in Randolph, Nebraska. Her current practice location is
106 E Wayne St, Randolph, Nebraska. You can reach out to her office (for appointments etc.) via phone at
(402) 337-0200.
Dr Kelly Leigh Bullock is licensed to practice in Nebraska (license number 461) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1407941057.
Physician's Profile
| Full Name | Dr Kelly Leigh Bullock |
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| Gender | Female |
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| Speciality | Family Medicine |
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| Location | 106 E Wayne St, Randolph, Nebraska |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1407941057
- Provider Enumeration Date: 10/03/2006
- Last Update Date: 02/15/2022
Medicare PECOS Information:
- PECOS PAC ID: 2769483858
- Enrollment ID: I20070116000077
Medical Identifiers
Medical identifiers for Dr Kelly Leigh Bullock such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1407941057 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 461 (Nebraska) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kelly Leigh Bullock allows following entities to bill medicare on her behalf.
| Entity Name | Osmond General Hospital Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1700979614
PECOS PAC ID: 4183689227
Enrollment ID: O20041130000809 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kelly Leigh Bullock is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Kelly Leigh Bullock, DO
1415 Charolais Drive,
Norfolk, NE 68701
Ph: (402) 379-1997 | Dr Kelly Leigh Bullock, DO
106 E Wayne St,
Randolph, NE 68771-5300
Ph: (402) 337-0200 |
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