Individual provider Active NPI

Stephanie Marie Fulks, NP

  • Gerontology Nurse Practitioner
  • Indianapolis, IN
National Provider Identifier
1780399907
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
71013487A Issued in IN
Practice address
1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone
(317) 944-5000
NPI assigned
Jan 23, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 71013487A IN
Gerontology Nurse Practitioner 363LG0600X 71013487A IN Primary
Registered Nurse 163W00000X 28229839A IN

Addresses

Primary practice location

1701 N Senate Blvd
Indianapolis, IN 46202-1239

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

1500 N Ritter Ave
Indianapolis, IN 46219-3027
Phone (317) 918-3848

Other identifiers 3

IdentifierTypeStateIssuer
300071683MedicaidIN
28229839AOtherINNURSING BOARD LICENSE
71013487AOtherINAPRN PRESCRIPTIVE AUTHORITY LICENSE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address SFULKS@DIRECT.IUHEALTH.ORG Direct
Other URL ecommunity.com Community Health Network

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230222001540 IN Practitioner - Nurse Practitioner 2466825492 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians
Community Physician Network Specialty Care LLCGroup PAC ID 9931697265, 260 clinicians

Practice addresses (Care Compare)

1400 N Ritter Ave
Suite 520
Indianapolis, IN 46219-3052
Phone (317) 355-1234

8075 N Shadeland Ave
Indianapolis, IN 46250-2693
Phone (317) 621-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
28229839AINMDRegistered Nurse
71013487AINMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physician Network Specialty Care LLC CurrentSince Nov 25, 2025 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Mar 20, 2023 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Mar 20, 2023 Accepting new patients

Locations

5918 Reliable Pkwy
Chicago, IL 60686

5819 Reliable Pkwy
Chicago, IL 60686

1515 N Madison Ave
Anderson, IN 46011
Phone (317) 870-0488

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

8075 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 621-8000

1500 N Ritter Ave
Indianapolis, IN 46219
Phone (317) 355-5041

1400 N Ritter Ave
Ste 520
Indianapolis, IN 46219
Phone (317) 355-1234

Interoperability endpoints

  • Direct secure messaging: sfulks554039@ecommunitydirect.com

Organizations & group practices 3

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 1

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": "1674432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784764800000",
    "number": "1780399907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 N SENATE BLVD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021239",
            "telephone_number": "317-944-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 N Ritter Ave",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462193027",
            "country_code": "US",
            "telephone_number": "317-918-3848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULKS",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-23",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "71013487A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71013487A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28229839A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300071683",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSING BOARD LICENSE",
            "identifier": "28229839A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN PRESCRIPTIVE AUTHORITY LICENSE",
            "identifier": "71013487A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SFULKS@DIRECT.IUHEALTH.ORG",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1701 N Senate Blvd",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ecommunity.com",
            "affiliation": "Y",
            "affiliationName": "Community Health Network",
            "address_1": "1500 N Ritter Ave",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462193027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.