Tracie Fullove, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E-11276 Issued in AR

Practice address

3162 W Martin Luther King Blvd Ste 13-14
Fayetteville, AR 72704-7679

Phone

(479) 935-4834

Fax

(479) 249-9879

NPI assigned

Mar 31, 2016

Last updated

Jun 19, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 AR

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 1

Specialty

Family Practice

Education

University of Mississippi School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mercy Northwest Arkansas Ambulatory Services, LLCGroup PAC ID 3779827993, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mercy Northwest Arkansas Ambulatory Services LLC

  • Urgent Care Clinic/Center
  • Springdale, AR
  • NPI 1366922320
  Medicare reassignment Care Compare group NPD
• St Francis House Nwa, Inc

  dba Community Clinic Central Junior High

  • Federally Qualified Health Center (FQHC)
  • Springdale, AR
  • NPI 1821838996
  Medicare reassignment NPD
• St Francis House Nwa, Inc

  dba Community Clinic West Fork

  • Federally Qualified Health Center (FQHC)
  • West Fork, AR
  • NPI 1336986785
  NPD
• St. Francis House Nwa, Inc.

  dba Prairie Grove School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Prairie Grove, AR
  • NPI 1518389089
  NPD
• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  NPD (past)
• St. Francis House Nwa, Inc.

  dba Community Clinic Springdale Medical

  • Federally Qualified Health Center (FQHC)
  • Springdale, AR
  • NPI 1699785089
  NPD (past)
• St. Francis House Nwa, Inc.

  dba Community Clinic Rogers Medical

  • Federally Qualified Health Center (FQHC)
  • Rogers, AR
  • NPI 1710160098
  NPD (past)

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1962865659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 HAMPTON CIR APT G",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392112334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3162 W MARTIN LUTHER KING BLVD STE 13-14",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047679",
            "telephone_number": "479-935-4834",
            "fax_number": "479-249-9879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLOVE",
        "first_name": "TRACIE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-31",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-11276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devis Lynne Fruchtl, MHPP
• Stephanie Fry
• Fuel Your Freedom, PLLC
• James M Fuendeling, PH.D
• Kyle Christopher Fugett, D.V.M
• Fulmer and Johnson Foot & Ankle , P.a.
• Daniel C Fulmer, DPM
• Gerald Howard Funkhouser Jr., CRC CSM
• Paige Erin Funkhouser, M.S.
• John L Furlow, MD

• Family Medicine Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.