NPIMap

Individual provider Active NPI

Susan Laurel Fulmer, MD

  • Otolaryngology Physician
  • Rochester, NY
National Provider Identifier
1750506283
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
264766 Issued in NY
Practice address
990 South Ave Ste 207
Rochester, NY 14620-2762
Phone
(585) 758-5700
NPI assigned
Apr 17, 2007
Last updated
Sep 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 264766 NY Primary

Addresses

Primary practice location

990 South Ave Ste 207
Rochester, NY 14620-2762

Mailing address

601 Elmwood Ave Box 629
Rochester, NY 14642-0001
Phone (585) 758-5700

Other practice location 1

229 Parrish St
Suite 250
Canandaigua, NY 14424-1791
Phone (585) 394-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20120821000057 NY Practitioner - Otolaryngology 1951558303 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Otolaryngology AssociatesGroup PAC ID 2860395795, 36 clinicians

Practice addresses (Care Compare)

990 S Ave
Suite 207
Rochester, NY 14620-2762
Phone (585) 341-8003

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.27 of 100Reported as group
Quality
63.55
Promoting interoperability
99
Improvement activities
40
Cost
74.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
264766NYMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Otolaryngology Associates Otolaryngology CurrentSince Oct 1, 2023 Accepting new patients
Lakeside ENT & Allergy LLC. Otolaryngology CurrentSince Sep 1, 2012 Accepting new patients
Nicholas H. Noyes Memorial Hospital CurrentSince Oct 1, 2023 Accepting new patients
Lakeside Balance and Wellness, LLC PastSince Sep 1, 2012 Accepting new patients

Locations

229 Parrish St
Ste 250
Canandaigua, NY 14424
Phone (585) 394-8800

73 Buffalo St
Ste 100
Canandaigua, NY 14424

111 Clara Barton St
Dansville, NY 14437
Phone (585) 335-3100

2365 S Clinton Ave
Ste 200
Rochester, NY 14618
Phone (585) 275-0142

601 Elmwood Ave
#629
Rochester, NY 14642
Phone (585) 276-5181

990 South Ave
Ste 207
Rochester, NY 14620
Phone (585) 341-6660

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20310/brand/1/csg/1/fhir/r4
  • Direct secure messaging: sfulmer145167@direct.urmc.rochester.edu

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Frederick Ferris Thompson HospitalCanandaigua, NY, CCN 330074 Hospital Corporate Director (4%) Apr 28, 2023
MM Ewing Continuing Care CenterCanandaigua, NY, CCN 335345 Skilled nursing facility Corporate Director Apr 29, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1750506283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE BOX 629",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-758-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 SOUTH AVE STE 207",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146202762",
            "telephone_number": "585-758-5700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "229 Parrish St",
            "address_2": "Suite 250",
            "address_purpose": "LOCATION",
            "city": "Canandaigua",
            "state": "NY",
            "postal_code": "144241791",
            "country_code": "US",
            "telephone_number": "585-394-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULMER",
        "first_name": "SUSAN",
        "middle_name": "LAUREL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NY",
            "license": "264766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.