Kevin J Fullin, MD FACC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

27973 Issued in WI

Practice address

6308 8TH Ave
Suite 3060
Kenosha, WI 53143-5082

Phone

(262) 656-3650

Fax

(262) 656-3671

NPI assigned

Dec 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 2

Addresses

Other identifiers 2

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

Merit-based Incentive Payment System (MIPS)

Final score

83.15 of 100Reported as group

Quality

69.39

Promoting interoperability

100

Improvement activities

40

Cost

74.44

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.

• Froedtert South, Inc.

  • Family Medicine Physician
  • Kenosha, WI
  • NPI 1558305284
  Medicare reassignment NPD
• Kenosha Pathology Consultants

  • Anatomic Pathology & Clinical Pathology Physician
  • Kenosha, WI
  • NPI 1790812857
  NPD (past)

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407369600000",
    "number": "1346224532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "SUITE 3060",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435082",
            "telephone_number": "262-656-3650",
            "fax_number": "262-656-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "SUITE 3060",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435082",
            "telephone_number": "262-656-3650",
            "fax_number": "262-656-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLIN",
        "first_name": "KEVIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD FACC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2014-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "27973",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WI",
            "license": "27973",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30742900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346224532",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alison D Fritschler, APNP
• Froedtert South, Inc.
• FS Outpatient Imaging Center LLC
• Fulfilling a Need,LLC
• Emily Ellen Fulk, PA-C
• Patricia Fullin, ACUPUNCTURISTS
• Kaleigh E Fulmer, DDS
• Dequan M Gaddis Jr., CPHT
• Jui Siddharth Gaikwad
• Lauren Galicia Magnuson, OT

• Cardiovascular Disease Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Cardiovascular Disease Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; 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.