Active NPI
Daniel C Fulmer, DPM
- Foot & Ankle Surgery Podiatrist
- Fayetteville, AR
National Provider Identifier
1184658114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 155
- Practice address
- 2828 E Millennium PL
Suite 2
Fayetteville, AR 72703-6514 - Phone
- (479) 582-1199
- Fax
- (479) 582-1194
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 155 | AR | Primary |
Addresses
Primary practice location
2828 E Millennium PL
Suite 2
Fayetteville, AR 72703-6514
Mailing address
2828 E Millennium PL
Suite 2
Fayetteville, AR 72703-6514
Phone (479) 582-1199
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 021200117 | Other | AR | QUALCHOICE |
| 5X002 | Other | AR | BLUE SHIELD |
| 148310717 | Medicaid | AR | |
| 200021680A | Medicaid | OK | |
| 155 | Other | AR | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 155 | AR | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fulmer and Johnson Foot & Ankle , P.a. | Foot & Ankle Surgery | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Foot & Ankle Surgery Podiatrist
- Fayetteville, AR
- NPI 1205869229
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289347200000",
"number": "1184658114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2828 E MILLENNIUM PL",
"address_2": "SUITE 2",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727036514",
"telephone_number": "479-582-1199",
"fax_number": "479-582-1194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2828 E MILLENNIUM PL",
"address_2": "SUITE 2",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727036514",
"telephone_number": "479-582-1199",
"fax_number": "479-582-1194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULMER",
"first_name": "DANIEL",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2010-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "AR",
"license": "155",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE",
"identifier": "021200117",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "5X002",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "148310717",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200021680A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "155",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.