Charles Berry Fullenwider, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

12300 Issued in OK

Practice address

4318 W Okmulgee St
Muskogee, OK 74401-4648

Phone

(918) 683-1238

Fax

(918) 683-1239

NPI assigned

Sep 20, 2005

Last updated

May 1, 2023By the provider in NPPES

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 OK

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

Specialty

Neurosurgery

Education

University of Oklahoma College of Medicine, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Francis Hospital Muskogee Hospital, Muskogee, OK, CCN 370025

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cfullenwider110736@direct.saintfrancis.com
• FHIR API: https://api.platform.athenahealth.com/2065/brand/5/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Warren Clinic Inc

  • General Practice Physician
  • Tulsa, OK
  • NPI 1174582282
  Medicare reassignment Care Compare group NPD
• CNS Surgery Inc

  • Neurological Surgery Physician
  • Muskogee, OK
  • NPI 1396803060
  NPD Authorized official
• Muskogee Medical and Surgical Associates, LLC

  • Family Medicine Physician
  • Muskogee, OK
  • NPI 1184858375
  NPD (past)

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

• Saint Francis Hospital Muskogee Inc

  dba Saint Francis Hospital Muskogee

  • General Acute Care Hospital
  • Muskogee, OK
  • NPI 1386188837
  Care Compare affiliation

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1447245063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE STE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4318 W OKMULGEE ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744014648",
            "telephone_number": "918-683-1238",
            "fax_number": "918-683-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLENWIDER",
        "first_name": "CHARLES",
        "middle_name": "BERRY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OK",
            "license": "12300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100100060A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jack Friend, PTA
• Timothy J Frink, D.O.
• Heaven Frisbie, R.D.
• Robert Dan Froman
• Kimberly Jean Fuerstenberg, BSN, RN
• Robyn Joyce Fullerton, M.A., LPC
• Cassidy Lea Fulton
• Kaytie Nicole Furek
• Gaddy Discount Drug Inc (Gaddys Discount Drug)
• Kimberly R Gage, MD

• Neurological Surgery Physician in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Neurological Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.