Michael J Fulop, PSYD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

1049 Issued in OR

Practice address

2130 SW Jefferson St Ste 300
Portland, OR 97201-7711

Phone

(503) 539-4932

Fax

(503) 297-5744

NPI assigned

Jan 17, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Behavioral Neuropsychology LLC

  • Clinical Child & Adolescent Psychologist
  • Portland, OR
  • NPI 1851054266
  Medicare reassignment NPD Authorized official
• Robert W McLellarn, PHD

  • Cognitive & Behavioral Psychologist
  • Portland, OR
  • NPI 1174813539

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1245382456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 SW JEFFERSON ST STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972017711",
            "telephone_number": "503-539-4932",
            "fax_number": "503-297-5744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 SW JEFFERSON ST STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972017711",
            "telephone_number": "503-539-4932",
            "fax_number": "503-297-5744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULOP",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2022-09-06",
        "certification_date": "2021-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OR",
            "license": "1049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Fullerton, MSED
• Voneda Jane Fullerton, AA
• Ryan Austin Fullmer
• Alison Fulmer, M.D.
• Lilla Blanche Sophia Fulmer
• Brandon Joseph Fulps, CRM
• Katelyn Fulps
• Elise Jan Fulsang, MD
• Cindy M Fulton, PA-C
• Eleanor Margaret Fulton

• Clinical Child & Adolescent Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Child & Adolescent Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.