Douglas L Fulk, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

036091745 Issued in IL

Practice address

1200 Cedar CT
Carbondale, IL 62901-5334

Phone

(618) 529-8500

Fax

(618) 549-1000

NPI assigned

Dec 13, 2005

Sex

Male

Sole proprietor

Yes

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

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

Specialty

Diagnostic Radiology

Education

Saint Louis University School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

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

  MO

  Medicare reassignment NPD Authorized official
• Cedar Court Imaging LTD

  • Diagnostic Radiology Physician
  • Carbondale, IL
  • NPI 1801873666
  NPD Authorized official
• Logan Park Imaging LLC

  • Diagnostic Radiology Physician
  • Herrin, IL
  • NPI 1205831971
  NPD (past)
• Southern Illinois Pathology, PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Carbondale, IL
  • NPI 1588649024
  NPD (past)

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299628800000",
    "number": "1992780050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 969",
            "address_2": "ATTN: DEBBIE STRAUSS",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629030969",
            "telephone_number": "314-821-8055",
            "fax_number": "314-821-1833"
        },
        {
            "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",
            "fax_number": "618-549-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULK",
        "first_name": "DOUGLAS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2011-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036091745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091745-1",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frederick Gustave, D.D.S., PC
• Shannon Rachelle Freeman Weiss, BCBA
• Marykate Freeman, PSYD
• Nicholas Eugene Freyer
• Daniel Raymond Fulk, D.O.
• Sydelle Fulk, LCPC
• Jayla Funchess
• Pak K Fung, M.D.
• Madison Rose Funneman, MD
• Stephanie Gadbois, M.D.

• Diagnostic Radiology Physician in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.
• 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.