Fulcrum Osteopathic, LLC

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

Legal business name

FULCRUM OSTEOPATHIC, LLC

Practice address

525 NW 2ND St
Corvallis, OR 97330-6487

Phone

(541) 250-5994

Fax

(541) 638-4002

NPI assigned

May 23, 2022

Last updated

Dec 29, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Matthew Patrick Evitts, DONPI 1952368318

Title

Owner/Member

Phone

(541) 250-5994

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew P Evitts, DO

  • Neuromusculoskeletal Medicine & OMM Physician
  • Corvallis, OR
  • NPI 1952368318
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703808000000",
    "number": "1033857842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 NW 2ND ST",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306487",
            "telephone_number": "541-250-5994",
            "fax_number": "541-638-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 NW 2ND ST",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306487",
            "telephone_number": "541-250-5994",
            "fax_number": "541-638-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULCRUM OSTEOPATHIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-23",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "EVITTS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "541-250-5994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287713",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Kay Frost, O.D.
• Rowan Fry
• Alejandro Fuentes Bautista, DO
• Vikki Fuhrman
• Stacie Marie Fulcher, PA-C
• Full Bloom Natural Medicine, LLC (Full Bloom Natural Medicine)
• Mino Fuller
• Chantell N Fulton
• Tara Fulton
• Joshua A Funk, DPT

• Neuromusculoskeletal Medicine & OMM Physician in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.