Individual provider Active NPI

Paul David Fulling, MD

  • Anesthesiology Physician
  • Rockford, IL
National Provider Identifier
1952461576
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036-106473 Issued in IL
Practice address
5875 E Riverside Blvd
Rockford, IL 61114-4937
Phone
(815) 398-9491
Fax
(815) 381-7498
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 036-106473 IL Primary

Addresses

Primary practice location

5875 E Riverside Blvd
Rockford, IL 61114-4937

Mailing address

PO Box 735263
Chicago, IL 60673-5263

Other identifiers 1

IdentifierTypeStateIssuer
036106473MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120502000397 IL Practitioner - Anesthesiology 5991967259 Reassigns benefits to 3 organizations
I20230608003260 WI Practitioner - Anesthesiology 5991967259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthomidwest, PLLCGroup PAC ID 0749183713, 531 clinicians

Practice addresses (Care Compare)

324 Roxbury Rd
Rockford, IL 61107-5090
Phone (815) 398-9491

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-106473ILMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthomidwest, PLLC CurrentSince Jan 1, 2019 Accepting new patients
Rockford Health Physicians CurrentSince Aug 1, 2002 Accepting new patients
RMH Pathologists, LTD Current Accepting new patients
Orthomidwest, PLLC CurrentSince Jan 1, 2019 Accepting new patients
Anesthesia Associates, LTD CurrentSince May 2, 2017 Accepting new patients

Locations

770 Beloit Rd
Belvidere, IL 61008
Phone (815) 847-7060

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

1 Kish Hospital Dr
DeKalb, IL 60115
Phone (815) 754-1521

100 5th St
Oswego, IL 60543
Phone (630) 449-0085

535 Roxbury Rd
Rockford, IL 61107
Phone (815) 387-1717

324 Roxbury Rd
Rockford, IL 61107
Phone (815) 381-7339

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

5875 E Riverside Blvd
Rockford, IL 61114
Phone (779) 774-1270

8400 Lakeview Pkwy
Ste 800
Pleasant Prairie, WI 53158
Phone (262) 455-7548

Organizations & group practices 5

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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1952461576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735263",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5875 E RIVERSIDE BLVD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144937",
            "telephone_number": "815-398-9491",
            "fax_number": "815-381-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLING",
        "first_name": "PAUL",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036-106473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036106473",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.