Louis M Fulton, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

41378 Issued in MN

Practice address

1300 South Drive
Winnebago Mental Health Information
Winnebago, WI 54985-0009

Phone

(920) 235-4910

Fax

(920) 235-2931

NPI assigned

Oct 1, 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 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• County of Grant Dba Unified Community Services

  • Community/Behavioral Health Agency
  • Lancaster, WI
  • NPI 1588618789
  Medicare reassignment NPD
• County of Grant

  • Public Health or Welfare Agency
  • Lancaster, WI
  • NPI 1134281967
  NPD
• County of Grant Dba Unified Community Services

  • Community/Behavioral Health Agency
  • Dodgeville, WI
  • NPI 1053468066
  NPD

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

{
    "created_epoch": "1128124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525996800000",
    "number": "1093702383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 SOUTH DRIVE",
            "city": "WINNEBAGO",
            "state": "WI",
            "postal_code": "54985",
            "telephone_number": "920-235-4910",
            "fax_number": "920-237-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 SOUTH DRIVE",
            "address_2": "WINNEBAGO MENTAL HEALTH INFORMATION",
            "city": "WINNEBAGO",
            "state": "WI",
            "postal_code": "549850009",
            "telephone_number": "920-235-4910",
            "fax_number": "920-235-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "LOUIS",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-01",
        "last_updated": "2018-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MN",
            "license": "41378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626325900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jesse Elizabeth Childs, PA-C
• Cognitive Continuum Care
• Ann Patrice Decker, OTR
• Raul M Dejesus, M.D.
• Alejandro A Eisma, MD
• Carlo Gallo Gaanan, MD
• Susan Lisa Griswold, APNP
• Jeremiah Mobisa Gwaro, APNP
• Annette M Hart, PT
• Kimberly Sue Hoenecke, D.O.

• Child & Adolescent Psychiatry Physician in Winnebago, WI
• Providers in Winnebago, WI by specialty
• Child & Adolescent Psychiatry Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.