Emerick Fulton

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

719 W Lake Ave
Peoria, IL 61614-5941

Phone

(309) 408-1493

NPI assigned

May 14, 2024

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

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Edge Counseling and Wellness LLCGroup PAC ID 1951659465, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Edge Counseling and Wellness LLC

  • Clinical Social Worker
  • Peoria, IL
  • NPI 1790275485
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1750130571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9821 ASHBURY CT",
            "city": "HANNA CITY",
            "state": "IL",
            "postal_code": "615369690",
            "telephone_number": "309-253-9579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 W LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145941",
            "telephone_number": "309-408-1493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "EMERICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Fullenkamp, PT, DPT
• Mark A Fuller
• Sarah Fuller, P,T,
• Laura Marie Fullerton, APN
• Morgan Ann Fulton-Gorham, LCSW
• Kira Furkin, APN
• G&T Maintenance LLC
• G&T Maintenance LLC
• Gregory Lee Gaa, ATC, CSCS
• Elizabeth Gabel, M.D.

• Mental Health Counselor in Peoria, IL
• Providers in Peoria, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.