Ronald F Fullmer, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

M5186 Issued in ID

Practice address

500 W. Fort St.
# 111
Boise, ID 83702

Phone

(208) 422-1325

Fax

(208) 422-1319

NPI assigned

Jun 15, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Magic Valley Regional Medical Center

  • Psychiatric Hospital
  • Twin Falls, ID
  • NPI 1447208947
  NPD (past)
• Magic Valley Sleep Institute LLC

  • Sleep Medicine (Internal Medicine) Physician
  • Twin Falls, ID
  • NPI 1992494389
  NPD (past)
• St Luke'S Clinic LLC

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1790718229
  NPD (past)
• St Luke'S Magic Valley Regional Medical Center LTD

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1528002029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W. FORT ST.",
            "address_2": "# 111",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-422-1325",
            "fax_number": "208-422-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W. FORT ST.",
            "address_2": "# 111",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-422-1325",
            "fax_number": "208-422-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMER",
        "first_name": "RONALD",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "ID",
            "license": "M5186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001287500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00029394",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Marie Fulfer, MA, OTR/L
• Full Circle Health, Inc.
• Full Circle Health, Inc.
• Full Life Care
• Brian D Fuller, CRNA
• Teri Fullmer, ABO
• Barbara Nixon Fultz, COMS
• Darby Fulwider
• Vicki Funaiole
• Functional and Integrative Medicine of Idaho PA

• Pulmonary Disease Physician in Boise, ID
• Providers in Boise, ID by specialty
• Pulmonary Disease Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.