JEREMY SCOTT FULLINGIM (D.O.) – Diagnostic Radiology Physician, NPI 1255537304
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,801 DIAGNOSTIC RADIOLOGY in MN
Provider Addresses for JEREMY SCOTT FULLINGIM (D.O.)
3600 Minnesota Dr Ste 800
Edina, MN 554357915
Phone: (952) 595-1100
Type: Location
12029, South 14th Court, Jenks, Tulsa County, Oklahoma, 74037, United States
JENKS, OK 740374954
Phone: (918) 269-3359
Type: Mailing
16155 N 68TH WEST AVE
SKIATOOK, OK 740704313
Phone: (918) 269-3359
Type: Mailing
Dayco Products, 4500, South Garnett Road, Tulsa, Tulsa County, Oklahoma, 74146, United States
TULSA, OK 741465229
Phone: (918) 599-5031
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: 2020-01-31
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 |
|---|---|---|---|---|
| I20090710000584 | I | Diagnostic Radiology | OK | TBD |
| I20090917000124 | I | Diagnostic Radiology | TX | TBD |
| I20191202001764 | I | Diagnostic Radiology | AZ | TBD |
| I20200131000586 | I | Diagnostic Radiology | NM | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 71045 | X-ray of chest, 1 view | 1,722 | 1,601 | $0 |
| 77067 | Screening mammography | 1,496 | 1,496 | $0 |
| 77063 | Screening 3d breast mammography | 1,389 | 1,389 | $0 |
| 71046 | X-ray of chest, 2 views | 1,310 | 1,266 | $0 |
| 70450 | Ct scan head or brain without contrast | 595 | 586 | $0 |
Insurance plans in this area (ZIP 55435)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DIAGNOSTIC RADIOLOGY | OK | 71010 | X-ray of chest, 1 view, front | 2049 | 1702 |
| DIAGNOSTIC RADIOLOGY | OK | 73562 | X-ray of knee, 3 views | 96 | 87 |
| DIAGNOSTIC RADIOLOGY | OK | 76830 | Ultrasound pelvis through vagina | 19 | 19 |
| DIAGNOSTIC RADIOLOGY | OK | 77012 | Radiological supervision and interpretation of CT guidance for needle insertion | 11 | 11 |
| DIAGNOSTIC RADIOLOGY | OK | 78452 | Nuclear medicine study of vessels of heart using drugs or exercise multiple studies | 14 | 14 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OK | |
| - | OK | |
| - | OK | |
| Emergency Medicine | SC | |
| - | OK | |
| Family Practice | OK | |
| - | OK | |
| - | OK | |
| Internal Medicine, Hospice/Palliative Care | OK | |
| Emergency Medicine | OK |
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