Matthew Paul Fuller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA100048 Issued in MA

Practice address

55 Fruit St
Boston, MA 02114-2696

Phone

(617) 724-4100

Fax

(617) 726-7415

NPI assigned

Aug 25, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mfullerpa367137@direct.atrius.masshiway.net

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.

• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573
  Medicare reassignment NPD
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1871639914
  Medicare reassignment
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Beverly, MA
  • NPI 1114265634

  Physician Assistant

  NPD
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Chestnut Hill, MA
  • NPI 1952518391
  NPD

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

{
    "created_epoch": "1661385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1053030759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 STATION LNDG APT 522W",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021555055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142696",
            "telephone_number": "617-724-4100",
            "fax_number": "617-726-7415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MATTHEW",
        "middle_name": "PAUL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-25",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA100048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Elizabeth Fuller, MD
• Jon D. Fuller, MD
• Jonathan Fuller, STUDENT
• Madeline Rachel Fuller, MD
• Mark Joseph Fuller Jr., MT-BC, NMT
• Meredith Ann Fuller
• Quanesha Alunte Fuller, LCSW
• Daniel Jeremy Fulop
• Anne B Fulton, MD
• David Fulton, MD

• Physician Assistant in Boston, MA
• Providers in Boston, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.