NPIMap

Individual provider Active NPI

Blake Fulks, MD

  • Family Medicine Physician
  • Springfield, MO
National Provider Identifier
1528440534
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2015020398 Issued in MO
Practice address
1423 N Jefferson Ave # B100
Springfield, MO 65802-1917
Phone
(417) 269-8817
Fax
(417) 269-8744
NPI assigned
Jun 25, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2015020398 MO Primary

Addresses

Primary practice location

1423 N Jefferson Ave # B100
Springfield, MO 65802-1917

Mailing address

1423 N Jefferson Ave # B100
Springfield, MO 65802-1917
Phone (417) 269-8817

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180801000446 MO Practitioner - Family Practice 1951659325 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13852 US Hwy 160
Forsyth, MO 65653-5156
Phone (417) 546-3500

525 Branson Landing Blvd
Branson, MO 65616-2052
Phone (417) 335-7128

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.41 of 100Reported as group
Quality
76.32
Promoting interoperability
100
Improvement activities
40
Cost
81.7

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015020398MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lester E Cox Medical Centers CurrentSince Aug 1, 2018 Accepting new patients
Skaggs Community Hospital Association Family Medicine CurrentSince Aug 1, 2018 Accepting new patients
Skaggs Community Hospital Association Family Medicine Current Accepting new patients
Lester E. Cox Medical Centers Family Medicine Current Accepting new patients
Lester E Cox Medical Centers CurrentSince Aug 1, 2018 Accepting new patients
Skaggs Community Hospital Association CurrentSince Aug 1, 2018 Accepting new patients
Lester E Cox Medical Centers Family Medicine CurrentSince Jul 31, 2021 Accepting new patients
Lester E Cox Medical Centers CurrentSince Jul 31, 2021 Accepting new patients
Skaggs Community Hospital Association Past Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

3801 S National Ave
Ste 1122
Springfield, MO 65807

1423 N Jefferson Ave
#B100
Springfield, MO 65802
Phone (417) 269-8817

3805 S Kansas Expy
Ste A
Springfield, MO 65807
Phone (417) 269-6896

Organizations & group practices 10

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": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1528440534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 N JEFFERSON AVE # B100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658021917",
            "telephone_number": "417-269-8817",
            "fax_number": "417-269-8744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 N JEFFERSON AVE # B100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658021917",
            "telephone_number": "417-269-8817",
            "fax_number": "417-269-8744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULKS",
        "first_name": "BLAKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-25",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2015020398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.