NPIMap

Individual provider Active NPI

Eric J. Fulnecky, MD

  • Infectious Disease Physician
  • Springfield, MO
National Provider Identifier
1922176635
Registry record updated Jul 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
2004006990 Issued in MO
Practice address
1900 S National Ave
Suite 2955
Springfield, MO 65804-2265
Phone
(417) 820-3905
Fax
(417) 820-3528
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 2004006990 MO Primary

Addresses

Primary practice location

1900 S National Ave
Suite 2955
Springfield, MO 65804-2265

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Other identifiers 3

IdentifierTypeStateIssuer
209153907MedicaidMO
P00207385OtherRAILROAD MEDICARE
431560263OtherTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040818000000 MO Practitioner - Infectious DiseasePractitioner - Internal Medicine 7618940610 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Citizens Memorial HealthcareGroup PAC ID 4183528169, 144 clinicians

Practice addresses (Care Compare)

1500 N Oakland Ave
CMH Diabetes
Bolivar, MO 65613-3099
Phone (417) 328-6040

1630 E Primrose St
Springfield, MO 65804-7929
Phone (417) 885-4700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Citizens Memorial Healthcare CurrentSince Jun 4, 2018 Accepting new patients
Citizens Memorial Healthcare CurrentSince Jun 4, 2018 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Southwest Missouri Infectious Disease LLC Infectious Disease Past Accepting new patients
Southside Emergency Associates Past Accepting new patients

Locations

1155 W Parkview St
Ste 1G
Bolivar, MO 65613
Phone (417) 326-8700

1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000

1155 W Parkview St
#1
Bolivar, MO 65613

Interoperability endpoints

  • Direct secure messaging: efulnecky1046@directb.mercy.net

Organizations & group practices 6

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 5

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": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215734400000",
    "number": "1922176635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 S NATIONAL AVE",
            "address_2": "SUITE 2955",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042265",
            "telephone_number": "417-820-3905",
            "fax_number": "417-820-3528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULNECKY",
        "first_name": "ERIC",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2008-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MO",
            "license": "2004006990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209153907",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00207385",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "431560263",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.