Individual provider Active NPI

Kelley Fulghum, M.D.

  • Internal Medicine Physician
  • Murray, UT
National Provider Identifier
1770926933
Registry record updated May 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
9149493-1205 Issued in UT
Practice address
181 E Medical Tower Dr
Murray, UT 84107-4886
Phone
(801) 442-3059
NPI assigned
Apr 8, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 9149493-1205 UT Primary

Addresses

Primary practice location

181 E Medical Tower Dr
Murray, UT 84107-4886

Mailing address

50 N Medical Dr
Salt Lake City, UT 84132-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20160915001252 UT Practitioner - Internal Medicine 5698996395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Oklahoma College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

181 E Medical Tower Dr
Murray, UT 84107-4872
Phone (801) 314-4266

Hospital & facility affiliations

  • Intermountain Homecare Home Health Salt Lake Home health agency, South Jordan, UT, CCN 467030
  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010
  • Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044
  • Intermountain Health Riverton Hospital Hospital, Riverton, UT, CCN 460058
  • American Fork Hospital Hospital, American Fork, UT, CCN 460023
  • St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9149493-1205UTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Aug 15, 2016 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services Inc CurrentSince Aug 15, 2016 Accepting new patients
Ihc Health Services Inc Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

181 E Medical Tower Dr
Salt Lake City, UT 84107
Phone (801) 314-4266

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495497600000",
    "number": "1770926933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 E MEDICAL TOWER DR",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841074886",
            "telephone_number": "801-442-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULGHUM",
        "first_name": "KELLEY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-08",
        "last_updated": "2017-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "UT",
            "license": "9149493-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.