Elise Jan Fulsang, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD23553 Issued in OR

Practice address

300 N Graham St
Suite 200
Portland, OR 97227-1683

Phone

(503) 413-4134

Fax

(503) 413-1895

NPI assigned

Jun 13, 2005

Sex

Female

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Willamette Valley Clinics LLC

  • Family Medicine Physician
  • McMinnville, OR
  • NPI 1790740520

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302048000000",
    "number": "1952305385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24800 SE STARK ST.",
            "address_2": "SUITE 200",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "97030",
            "telephone_number": "503-674-1391",
            "fax_number": "503-413-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N GRAHAM ST",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271683",
            "telephone_number": "503-413-4134",
            "fax_number": "503-413-1895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULSANG",
        "first_name": "ELISE",
        "middle_name": "JAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-13",
        "last_updated": "2011-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD23553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232402",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alison Fulmer, M.D.
• Lilla Blanche Sophia Fulmer
• Michael J Fulop, PSYD
• Brandon Joseph Fulps, CRM
• Katelyn Fulps
• Cindy M Fulton, PA-C
• Eleanor Margaret Fulton
• Mallorie Fults
• Donald Fultz
• Margo Fultz, RN

• Internal Medicine Physician in Portland, OR
• Providers in Portland, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.