CHARLES O FULLENWIDER M.D.
NPI 1417299298
Anesthesiology - Pain Medicine in San Diego, CA

Q: What is Charles Fullenwider's NPI number?

The NPI number for Charles Fullenwider is 1417299298. It was assigned to this individual provider in the NPPES registry on March 20, 2013.

Q: What is Charles Fullenwider's specialty?

The primary specialty registered for this NPI is Anesthesiology, specializing in Pain Medicine, with taxonomy code 207LP2900X.

Active since March 20, 2013PECOS EnrolledAccepts Medicare Assignment

34800 BOB WILSON DR, SAN DIEGO, CA 92134(619) 532-8937 Get Directions Write a Review

NPPES record last updated: May 27, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 27, 2025, Dec 12, 2024, Jun 7, 2023 and 1 more (4 updates tracked since 2019).

On this page

About Charles O Fullenwider M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLES O FULLENWIDER M.D. (NPI 1417299298) is an individual pain medicine provider in San Diego, California, licensed in Oklahoma (31587) and active in the NPI registry since March 2013. He is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of University Of Oklahoma College Of Medicine (2013).

NPPES Registry Identity

NPI1417299298

Entity TypeIndividualMale

Primary Taxonomy207LP2900X

Provider Legal NameCHARLES O FULLENWIDERCredential: M.D.

Location Address34800 BOB WILSON DRSan Diego, CA 92134-1098

Mailing Address333 S 38th St, Suite FMuskogee, OK 74401-4937

Phone(619) 532-8937

Sole ProprietorNo

Medical School CMSUniversity Of Oklahoma College Of MedicineGraduated 2013

Enumeration DateMarch 20, 2013

Last NPPES UpdateMay 27, 20254 updates tracked since enumeration

NPPES CertifiedDecember 12, 2024

✔ NPI 1417299298 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyAnesthesiology · Pain MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207LP2900X

License✔ Licensed in OK · 31587

Definition

An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists.

Also ListedAnesthesiologyTaxonomy 207L00000X · License 31587 (OK)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

34800 BOB WILSON DR, San Diego, CA 92134

Open in Google Maps ↗

Secondary Practice Locations 2

Location 18901 Rockville PikeBethesda, MD 20889-0001 · Phone (301) 295-4000

Location 27050 Air Depot BlvdTinker AFB, OK 73145-8716 · Phone (405) 734-2778

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Charles O Fullenwider M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9032595954

PECOS Enrollment IDI20250602001792

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LORENA MARIE FUJII N.P.

Nurse Practitioner (Pediatrics)