D. Shane Fulmer, O.T.

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

748 Issued in TN

Practice address

260 Fort Sanders West Blvd
Suite 110
Knoxville, TN 37922-3355

Phone

(865) 558-4491

Fax

(865) 558-4493

NPI assigned

Apr 14, 2006

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: david.fulmer.p1@direct.orthotn.nextgenshare.com

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.

• Hovis Orthopaedic Clinic PC

  • Orthopaedic Surgery Physician
  • Knoxville, TN
  • NPI 1053392043
  NPD (past)
• Orthotennessee

  • Multi-Specialty Clinic/Center
  • Knoxville, TN
  • NPI 1841508751
  NPD (past)
• Orthotennessee, PC

  • Multi-Specialty Clinic/Center
  • Powell, TN
  • NPI 1518043751
  NPD (past)

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1851355879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 FORT SANDERS WEST BLVD",
            "address_2": "SUITE 110",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223355",
            "telephone_number": "865-558-4491",
            "fax_number": "865-558-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 FORT SANDERS WEST BLVD",
            "address_2": "SUITE 110",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223355",
            "telephone_number": "865-558-4491",
            "fax_number": "865-558-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULMER",
        "first_name": "D. SHANE",
        "credential": "O.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5942420",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3656592",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4111141",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Fuller, DPT
• Katherine L Fuller, AUD
• Lisa Ann Fuller, FNP-BC
• Lisa Ellen Fuller, MS, RD, LDN
• Teia Squires Fuller, PT, DPT
• Paula Katherine Fulton, NNP
• Sarah Fulton
• John Fultz
• Lauren Fultz
• Functional Pathways of Tennessee LLC

• All providers in Knoxville, TN
• Occupational Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.