Individual provider Active NPI

Nancy Fulton

  • Speech-Language Pathologist
  • Clackamas, OR
National Provider Identifier
1871976076
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
011761 Issued in OR
Practice address
10180 SE Sunnyside Rd
Clackamas, OR 97015-8970
Phone
(503) 571-7112
NPI assigned
Jul 7, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 011761 OR Primary

Addresses

Primary practice location

10180 SE Sunnyside Rd
Clackamas, OR 97015-8970

Mailing address

16221 SE Van Zyl Dr
Damascus, OR 97089-8814
Phone (503) 252-6788

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180702001754 OR Practitioner - Qualified Speech Language Pathologist 7416203666 Reassigns benefits to 1 organization
I20230328002615 WA Practitioner - Qualified Speech Language Pathologist 7416203666 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
011761ORMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Dec 21, 2022 Accepting new patients

Locations

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1871976076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16221 SE VAN ZYL DR",
            "city": "DAMASCUS",
            "state": "OR",
            "postal_code": "970898814",
            "telephone_number": "503-252-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10180 SE SUNNYSIDE RD",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970158970",
            "telephone_number": "503-571-7112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULTON",
        "first_name": "NANCY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-07",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OR",
            "license": "011761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10180 SE Sunnyside Rd",
            "city": "Clackamas",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970158970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.