MARY KAY BULTMAN PMHNP
NPI 1639627110
Nurse Practitioner - Psychiatric/Mental Health in Milwaukee, WI
About Mary Kay Bultman Pmhnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARY KAY BULTMAN PMHNP (NPI 1639627110) is an individual psychiatric/mental health provider in Milwaukee, Wisconsin, licensed in Wisconsin (7252-33) and active in the NPI registry since September 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2016).
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Mary Kay Bultman Pmhnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Mary Kay Bultman reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Milwaukee, WI 53211
- Reassigned Medicare billing, Wisconsin enrollment
- 22 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 53233 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mary Kay Bultman's NPI number?
The NPI number for Mary Kay Bultman is 1639627110. It was assigned to this individual provider in the NPPES registry on September 14, 2016.
Where is Mary Kay Bultman located?
Mary Kay Bultman practices at 1020 N 12th St Fl 4, Milwaukee, WI 53233. The listed phone number is (414) 219-2000.
What is Mary Kay Bultman's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Mary Kay Bultman enrolled in Medicare?
Yes. Mary Kay Bultman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Mary Kay Bultman's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Kay Bultman reassigns Medicare benefits to Lighthouse Clinic Ltd (Milwaukee, WI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Kay Bultman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mary Kay Bultman accept?
Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), HealthPartners, Network Health and UnitedHealthcare list Mary Kay Bultman as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Mary Kay Bultman was last updated on September 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 30 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mary Kay Bultman, PMHNP · NPI 1639627110
Psychiatric/Mental Health physician in Milwaukee, Wisconsin. Individual provider, active in the CMS NPPES registry since September 14, 2016.
## Identity
- **NPI:** 1639627110 (Entity type: Individual)
- **Enumerated:** September 14, 2016
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 7252-33 (Wisconsin)
- **Sole proprietor:** No
## Practice location
- **Address:** 1020 N 12TH ST FL 4, Milwaukee, WI 53233-1308
- **Phone:** (414) 219-2000 · **Fax:** (414) 219-7402
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Lighthouse Clinic Ltd (NPI 1912216219, Milwaukee, WI), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2016
## Record status
- **NPPES last updated:** September 30, 2026
- **Other identifiers:** Medicaid 100062610 (WI); Medicaid 100080285 (WI)
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Source: [NPI Profile](https://npiprofile.com/npi/1639627110) · Data from the CMS NPPES public registry.