Individual provider Active NPI

Clifford Thomas Fulton, MD

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1508093030
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301094602 Issued in MI
Practice address
100 Michigan St NE
Grand Rapids, MI 49503-2560
Phone
(616) 391-3139
NPI assigned
Jun 11, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301094602 MI Primary

Addresses

Primary practice location

100 Michigan St NE
Grand Rapids, MI 49503-2560

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20120924000801 MI Practitioner - HospitalistPractitioner - Internal Medicine 7315195989 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Indiana University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apogee Medical Group Michigan PCGroup PAC ID 9931347879, 42 clinicians

Practice addresses (Care Compare)

850 W Baraga Ave
Marquette, MI 49855-4550
Phone (906) 449-3747

Hospital & facility affiliations

  • Uphs Marquette DLP Hospital Hospital, Marquette, MI, CCN 230054
  • Osf St Francis Hospital and Medical Group Hospital, Escanaba, MI, CCN 231337

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Borgess Hospital CurrentSince Aug 1, 2012 Accepting new patients
Ascension Borgess Hospital CurrentSince Aug 1, 2012 Accepting new patients
Hospitalist Medicine Physicians of Michigan, PLLC Internal Medicine Current Accepting new patients
Ascension Borgess Hospital Current Accepting new patients
Sound Inpatient Physicians - Michigan, PLLC Internal Medicine CurrentSince May 29, 2019 Accepting new patients
Apogee Medical Group, Michigan, PC Internal Medicine CurrentSince Sep 1, 2016 Accepting new patients
Hospitalist Medicine Physicians of Michigan PLLC Internal Medicine CurrentSince Jun 1, 2019 Accepting new patients
Sound Inpatient Physicians-Michigan, PLLC Internal Medicine Current Accepting new patients
DLP Marquette General Hospital LLC Past Accepting new patients

Locations

15059 N Scottsdale Rd
Ste 600
Scottsdale, AZ 85254
Phone (602) 778-3601

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

3025 Gull Rd
Kalamazoo, MI 49048
Phone (269) 343-1264

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

850 W Baraga Ave
Marquette, MI 49855
Phone (906) 225-3595

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Organizations & group practices 9

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 2

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": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1508093030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "CLIFFORD",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-11",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301094602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.