JUSTIN SCOTT FULKERSON (ACNP-BC, CRNA) – Acute Care Nurse Practitioner, NPI 1144500018
Acute Care Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,265 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in IL
Provider Addresses for JUSTIN SCOTT FULKERSON (ACNP-BC, CRNA)
1775 Dempster St
Park Ridge, IL 600681143
Phone: (847) 723-2210
Fax: (847) 723-3532
Type: Location
4500 S LANCASTER RD
DALLAS VAMC
DALLAS, TX 752167167
Phone: (803) 730-2778
Type: Mailing
1997 NE 15TH AVE
WILTON MANORS, FL 333053262
Phone: (803) 730-2778
Type: Mailing
4500 S Lancaster Rd
Dallas VAMC
Dallas, TX 752167167
Phone: (803) 730-2778
Type: Location
6766 W SUNRISE BLVD STE 100
PLANTATION, FL 333136072
Phone: (954) 583-8472
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-06-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 4 Medicare enrollment records; no due dates published yet.
Enrollment records
4
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120210000807 | I | Nurse Practitioner | IL | TBD |
| I20221208002277 | I | Certified Registered Nurse Anesthetist (Crna) | SC | TBD |
| I20240328001191 | I | Certified Registered Nurse Anesthetist (Crna) | IN | TBD |
| I20250609002799 | I | Certified Registered Nurse Anesthetist (Crna) | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60068)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| A N E S T H E S I O L O G Y | IL | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| - | MO | |
| Certified Registered Nurse Anesthetist (Crna) | AZ | |
| Certified Registered Nurse Anesthetist (Crna) | OH | |
| A N E S T H E S I O L O G Y | OH | |
| A N E S T H E S I O L O G Y | OR | |
| - | IL | |
| - | KS | |
| - | IN |
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