Dr Kelly Leigh Bullock, DO is a medicare enrolled "Family Medicine" physician in Randolph, Nebraska. She graduated from medical school in 2000 and has 26 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Osmond General Hospital Inc, Perkins County Hospital District and 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
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and 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 Practice |
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| Experience | 26 Years |
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| Location | 106 E Wayne St, Randolph, Nebraska |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Kelly Leigh Bullock graduated from medical school in 2000
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 |
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| 1407941057 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 461 (Nebraska) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Osmond General Hospital Inc | 4183689227 | 7 |
| Perkins County Hospital District | 0840109823 | 22 |
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 |
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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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