NPIMap

Individual provider Active NPI

Jonathan H Fuller, D.O.

  • Family Medicine Physician
  • Gadsden, AL
National Provider Identifier
1013315001
Registry record updated Jan 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO.1762 Issued in AL
Practice address
1401 Rainbow Dr Ste B
Gadsden, AL 35901-5319
Phone
(256) 646-6358
Fax
(256) 467-3098
NPI assigned
Dec 8, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 24416 MS
Family Medicine Physician 207Q00000X DO.1762 AL Primary

Addresses

Primary practice location

1401 Rainbow Dr Ste B
Gadsden, AL 35901-5319

Mailing address

PO Box 860
Gadsden, AL 35902-0860
Phone (256) 646-6358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180628001046 AL Practitioner - Family PracticePractitioner - Other (Physician) 1658643432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
William Carey University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1401 Rainbow Dr
Suite B
Gadsden, AL 35901-5319
Phone (256) 646-6358

Hospital & facility affiliations

  • Alabama Homecare of Gadsden Home health agency, Gadsden, AL, CCN 017115
  • Enhabit Home Health Home health agency, Hoover, AL, CCN 017009
  • Amedisys Home Health of Anniston Home health agency, Anniston, AL, CCN 017305
  • Centerwell Home Health Home health agency, Rainbow City, AL, CCN 017018
  • Prohealth Home Health, LLC Home health agency, Huntsville, AL, CCN 017178
  • Riverview Regional Medical Center Hospital, Gadsden, AL, CCN 010046
  • Gadsden Regional Medical Center Hospital, Gadsden, AL, CCN 010040
  • Marshall Medical Centers Hospital, Boaz, AL, CCN 010005

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO.1762ALMDFamily Medicine Physician
24416MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinic of Gadsden, PC Family Medicine CurrentSince Oct 19, 2017 Accepting new patients

Locations

1401 Rainbow Dr
#B
Gadsden, AL 35901
Phone (256) 543-9497

Networks

  • devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
  • FL PPO
  • MS PPO
  • MS PPO D-SNP
  • devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
  • TN PPO
  • devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
  • AL HMO D-SNP
  • AL HMO
  • FL HMO D-SNP
  • MS PPO C-SNP

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HHICBD/Endpoint/HHICBD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516060800000",
    "number": "1013315001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359020860",
            "telephone_number": "256-646-6358",
            "fax_number": "256-467-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 RAINBOW DR STE B",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359015319",
            "telephone_number": "256-646-6358",
            "fax_number": "256-467-3098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JONATHAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-08",
        "last_updated": "2018-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "24416",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO.1762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gadsden, AL

Sources for this page

Verify at the official NPI Registry.