DR. THOMAS LANCE FULGHUM MD
NPI 1760226716
Student in an Organized Health Care Education/Training Program in Green Bay, WI

Q: What is Thomas Fulghum's NPI number?

The NPI number for Thomas Fulghum is 1760226716. It was assigned to this individual provider in the NPPES registry on June 24, 2024.

Q: What is Thomas Fulghum's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Thomas Fulghum was last updated on July 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 24, 2024PECOS Enrolled

3021 VOYAGER DR, GREEN BAY, WI 54311(920) 431-1810 Get Directions Write a Review

NPPES record last updated: July 1, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 1, 2025, Aug 15, 2024, Jun 24, 2024 (3 updates tracked since 2024).

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About Dr. Thomas Lance Fulghum Md NPPES

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

DR. THOMAS LANCE FULGHUM MD (NPI 1760226716) is an individual student in an organized health care education/training program in Green Bay, Wisconsin, licensed in Wisconsin (101347-851) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1760226716

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDR. THOMAS LANCE FULGHUMCredential: MD

Location Address3021 VOYAGER DRGreen Bay, WI 54311-8303

Mailing AddressPo Box 19070Green Bay, WI 54307-9070 · (920) 431-1810

Phone(920) 431-1810

Sole ProprietorYes

Enumeration DateJune 24, 2024

Last NPPES UpdateJuly 1, 20253 updates tracked since enumeration

NPPES CertifiedJuly 1, 2025

✔ NPI 1760226716 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in WI · 101347-851

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedFamily MedicineTaxonomy 207Q00000X · License 125-084945 (IL)

3021 VOYAGER DR, Green Bay, WI 54311

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Thomas Lance Fulghum Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

DR. SARA CHEEMA MD

Student in an Organized Health Care Education/Training Program