Carmella L Fullenwider, AG-PCNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

10027848 Issued in OR

Practice address

645 NW 4TH St
Redmond, OR 97756-1502

Phone

(541) 389-7741

NPI assigned

Jun 17, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Bay Area Hospital DistrictGroup PAC ID 2163331000, 117 clinicians

Praxis Health PCGroup PAC ID 8325941446, 174 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bay Area Hospital Hospital, Coos Bay, OR, CCN 380090
• St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047
• Curry General Hospital Hospital, Gold Beach, OR, CCN 381322
• Coquille Valley Hospital Hospital, Coquille, OR, CCN 381312
• Southern Coos Hospital & Health Center Hospital, Bandon, OR, CCN 381304

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cfullenwider205215@secure.stcharleshealthcare.org

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.

• Bay Area Hospital District

  • General Acute Care Hospital
  • Coos Bay, OR
  • NPI 1225016561
  Medicare reassignment Care Compare group NPD
• Praxis Health, PC

  • Multi-Specialty Clinic/Center
  • Bend, OR
  • NPI 1821068164
  Medicare reassignment Care Compare group NPD
• Bay Area Hospital District

  • Home Health Agency
  • North Bend, OR
  • NPI 1215018197
  NPD
• Praxis Health, PC

  • Rural Health Clinic/Center
  • Dallas, OR
  • NPI 1942925326
  NPD

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

• Bay Area Hospital District

  • General Acute Care Hospital
  • Coos Bay, OR
  • NPI 1225016561
  Care Compare affiliation
• Cascade Healthcare Community Inc

  • Sleep Disorder Diagnostic Clinic/Center
  • Bend, OR
  • NPI 1164675963

  Hospital

  Care Compare affiliation
• Coquille Valley Hospital District

  • Critical Access Hospital
  • Coquille, OR
  • NPI 1730223967
  Care Compare affiliation
• Curry Health District

  • Critical Access Hospital Clinic/Center
  • Brookings, OR
  • NPI 1083656367
  Care Compare affiliation
• Curry Health District

  • Critical Access Hospital
  • Gold Beach, OR
  • NPI 1487696985
  Care Compare affiliation
• Southern Coos Health District

  • Critical Access Hospital
  • Bandon, OR
  • NPI 1588684484
  Care Compare affiliation
• St. Charles Health System, Inc.

  • General Acute Care Hospital
  • Bend, OR
  • NPI 1982621447
  Care Compare affiliation

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1598508640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1517",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010410",
            "telephone_number": "541-278-4332",
            "fax_number": "541-278-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 NW 4TH ST",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977561502",
            "telephone_number": "541-389-7741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLENWIDER",
        "first_name": "CARMELLA",
        "middle_name": "L",
        "credential": "AG-PCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OR",
            "license": "10027848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard John Friday, LCSW
• Kyle Jay Frisinger, DMD
• Marissa Fritzler
• Karen Michele Fry
• Marissa Lauren Fuentes, CRM
• Lori Funk
• Brenna Fuoti
• Jessie Gallaher
• Gambee Family Dental LLC
• Celso A Gangan Jr., M.D

• Primary Care Nurse Practitioner in Redmond, OR
• Providers in Redmond, OR by specialty
• Primary Care Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.