ANDREA B FULCOMER (PA-C) – Physician Assistant, NPI 1972552131
Physician Assistant
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Loading map...
Provider Addresses for ANDREA B FULCOMER (PA-C)
2404, Charles Street, Rockford, Winnebago County, Illinois, 61108, United States
ROCKFORD, IL 611081602
Phone: (779) 696-7910
Type: Location
7974 UW HEALTH CT
MIDDLETON, WI 535625531
Phone:
Type: Mailing
5543 E CHERYL PKWY
FITCHBURG, WI 537115376
Phone: (608) 274-5300
Type: Location
PO BOX 78866
MILWAUKEE, WI 532788866
Phone: (779) 696-7150
Type: Mailing
3505 N BELL SCHOOL RD
ROCKFORD, IL 611146624
Phone: (779) 696-0300
Type: Location
Rockford Post Office, 401, South Main Street, Downtown Rockford, Rockford, Rockford Township, Winnebago County, Illinois, 61101, United States
ROCKFORD, IL 611100067
Phone: (779) 696-7150
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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: 2025-10-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20161222000825 | I | Physician Assistant | IL | TBD |
| I20251023003704 | I | Physician Assistant | WI | 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 61108)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| - | WI | |
| Nurse Practitioner | WI | |
| Nurse Practitioner | WI | |
| Family Practice | WI | |
| - | WI | |
| - | WI | |
| - | WI | |
| Endocrinology, Internal Medicine | WI | |
| Medical Oncology, Hematology/Oncology | CA |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.