David A Fullenkamp, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002167A Issued in IN

Practice address

1111 N Meridian St
Portland, IN 47371-1024

Phone

(260) 726-4210

Fax

(260) 726-9347

NPI assigned

Dec 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

David a. Fullenkamp O.D P.CGroup PAC ID 0547308033, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• David a. Fullenkamp, O.D., P.C.

  • Optometrist
  • Portland, IN
  • NPI 1346479284
  Medicare reassignment Care Compare group NPD Authorized official
• Indiana Vision Group, LLC

  • Optometrist
  • Winchester, IN
  • NPI 1326893348
  Medicare reassignment
• Indiana Vision Group, LLC

  • Optometrist
  • Portland, IN
  • NPI 1063349561
  NPD (past)

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259020800000",
    "number": "1043297625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1268",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473713268",
            "telephone_number": "260-726-4210",
            "fax_number": "260-726-9347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 N MERIDIAN ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473711024",
            "telephone_number": "260-726-4210",
            "fax_number": "260-726-9347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLENKAMP",
        "first_name": "DAVID",
        "middle_name": "A",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2009-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002167A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100147120",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2090544",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rebekah S Ferrell, RN, FNP
• Carla Ann Ford, L.C.S.W.
• Ruth A Funk
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• Todd Gaerke
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• Malcolm Christian George, D.D.S.

• Optometrist in Portland, IN
• Providers in Portland, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.