Charles Samuel Fulk

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD014379 Issued in TN

Practice address

400 E Economy Road
Suite 8
Morristown, TN 37814-3388

Phone

(423) 587-4600

Fax

(423) 587-1729

NPI assigned

May 17, 2006

Last updated

Jan 2, 2015By the provider in NPPES

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Dermatology

Education

Wake Forest University School of Medicine, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeway Dermatology Associates PCGroup PAC ID 3678892684, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cfulk@lakewayderm.emadirect.md

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.

• Lakeway Dermatology Associates PC

  • Dermatology Physician
  • Morristown, TN
  • NPI 1386031979
  Medicare reassignment Care Compare group NPD
• Lakeway Dermatology Associates, PC

  • Dermatology Physician
  • Morristown, TN
  • NPI 1114123056
  NPD

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420156800000",
    "number": "1801848668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E ECONOMY RD",
            "address_2": "SUITE 8",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143388",
            "telephone_number": "423-587-4600",
            "fax_number": "423-587-1729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E ECONOMY ROAD",
            "address_2": "SUITE 8",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143388",
            "telephone_number": "423-587-4600",
            "fax_number": "423-587-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULK",
        "first_name": "CHARLES",
        "middle_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2015-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD014379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "070000633",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0024632",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3715864",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "TN0102",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bibiana Antenorio Franklin
• Tammy Lynn Franklin, MS, NCC
• Nathan McNeil French, M.S., CCC-SLP
• Fresenius Medical Care Morristown, LLC (Fresenius Medical Care Morristown)
• Catherine Jennifer Frier, DPT
• Mistie Dawn Fulk
• Bradley Kenneth Fullbright, PA
• George Hugh Fulmer
• Tiffany Fulton
• Terry Curtis Fultz, DO

• Specialist in Morristown, TN
• Providers in Morristown, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; 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.