DR. KELLY LEIGH BULLOCK (D.O.) – Family Medicine Physician, NPI 1407941057
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
954 FAMILY PRACTICE in NE
Provider Addresses for DR. KELLY LEIGH BULLOCK (D.O.)
106 E WAYNE ST
RANDOLPH, NE 687715300
Phone: (402) 337-0200
Fax: (402) 337-1020
Type: Location
North 27th Street, Norfolk, Madison County, Nebraska, 68702, United States
NORFOLK, NE 687014457
Phone: (402) 644-7407
Fax: (402) 644-7406
Type: Location
1415, Charolais Drive, Norfolk, Madison County, Nebraska, 68701, United States
NORFOLK, NE 68701
Phone: (402) 379-1997
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-01-16
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070116000077 | I | Family Practice | NE | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 68771)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | NE | |
| Family Practice | NE | |
| Family Practice | NE | |
| Nurse Practitioner | NE | |
| Nurse Practitioner | NE | |
| Physician Assistant | NE | |
| Family Practice | NE | |
| Nurse Practitioner | NE | |
| Orthopedic Surgery | CO | |
| - | CO |
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