Daniel Raymond Fulk, D.O.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036.128075 Issued in IL

Practice address

1200 Cedar CT
Carbondale, IL 62901-5334

Phone

(618) 529-8500

NPI assigned

Jul 3, 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

Medicare fee-for-service enrollment

Enrolled in IL, MO2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Radiologic Interpretations of Southern Illinois LTD

  • Radiologic Technologist
  • Carbondale, IL
  • NPI 1730218652

  IL, MO

  Medicare reassignment NPD
• Cedar Court Imaging LTD

  • Diagnostic Radiology Physician
  • Carbondale, IL
  • NPI 1801873666

  Diagnostic Radiology

  NPD

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308096000000",
    "number": "1962432286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CEDAR CT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015334",
            "telephone_number": "618-529-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CEDAR CT",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015334",
            "telephone_number": "618-529-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULK",
        "first_name": "DANIEL",
        "middle_name": "RAYMOND",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2011-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036.128075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Fred, M.S., CRC
• Frederick Gustave, D.D.S., PC
• Shannon Rachelle Freeman Weiss, BCBA
• Marykate Freeman, PSYD
• Nicholas Eugene Freyer
• Douglas L Fulk, M.D.
• Sydelle Fulk, LCPC
• Jayla Funchess
• Pak K Fung, M.D.
• Madison Rose Funneman, MD

• All providers in Carbondale, IL
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.