Individual provider Active NPI

Daniel H Fulkerson, M.D.

  • Neurological Surgery Physician
  • South Bend, IN
National Provider Identifier
1386802387
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
01068116A Issued in IN
Practice address
100 Navarre PL Ste 6600
South Bend, IN 46601-1173
Phone
(574) 647-8800
Fax
(574) 647-8896
NPI assigned
May 27, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 01068116A IN Primary

Addresses

Primary practice location

100 Navarre PL Ste 6600
South Bend, IN 46601-1173

Mailing address

3245 Health Dr.
Suite 100
Granger, IN 46530-3245
Phone (547) 647-1840

Other practice location 1

500 Arcade Ave Ste 200
Elkhart, IN 46514-2485
Phone (574) 294-8404

Other identifiers 1

IdentifierTypeStateIssuer
200983330MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dhfulkerson@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100724000011 IN Practitioner - Neurosurgery 4486786597 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Indiana University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

100 Navarre PL
6600 BMG N Central Neurosurgery SB
South Bend, IN 46601-1173
Phone (574) 647-8800

Hospital & facility affiliations

  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Laminectomy or laminotomy (partial removal of spine bones)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group Inc CurrentSince Jul 1, 2018 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group, Inc. Neurological Surgery CurrentSince Jul 1, 2018 Accepting new patients
Major Hospital Past Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

500 Arcade Ave
Ste 200
Elkhart, IN 46514
Phone (574) 293-3317

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

900 I St
Laporte, IN 46350
Phone (219) 324-1670

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

100 Navarre Pl
Ste 6600
South Bend, IN 46601
Phone (574) 232-7227

Interoperability endpoints

  • Direct secure messaging: dhfulkerson@mybeacon.cernerdirect.com
  • Direct secure messaging: dfulkerson1147638@direct.trinity-health.org
  • Direct secure messaging: dfulkerson10403@direct.franciscanalliance.org

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1386802387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR.",
            "address_2": "SUITE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465303245",
            "telephone_number": "547-647-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NAVARRE PL STE 6600",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011173",
            "telephone_number": "574-647-8800",
            "fax_number": "574-647-8896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Arcade Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142485",
            "country_code": "US",
            "telephone_number": "574-294-8404",
            "fax_number": "574-523-1642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULKERSON",
        "first_name": "DANIEL",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-27",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "IN",
            "license": "01068116A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200983330",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dhfulkerson@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "500 Arcade Ave Ste 200",
            "city": "Elkhart",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465142485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.