Corey Brandon Fuller, MD

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

A118405 Issued in CA

Practice address

25455 Barton Rd Ste 102B
Loma Linda, CA 92354-3139

Phone

(909) 558-6444

Fax

(909) 558-6118

NPI assigned

Apr 7, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Sports MedicineAlso: Orthopedic Surgery

Education

Loma Linda University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sac Health SystemGroup PAC ID 4385533579, 222 clinicians

Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.87 of 100Reported as group

Quality

72.13

Promoting interoperability

80

Improvement activities

40

Cost

77.36

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cfuller6997@direct.llu.edu

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.

• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment Care Compare group NPD
• Sac Health System

  dba SAC Arrowhead

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1013935923
  Medicare reassignment Care Compare group NPD
• Legacy Clinics LLC

  • Clinic/Center
  • Portland, OR
  • NPI 1902827272
  Medicare reassignment
• Faculty Physicians and Surgeons of Llusm

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1558311373
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Sac Health System

  • Federally Qualified Health Center (FQHC)
  • Rialto, CA
  • NPI 1386266112
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Orthopaedic Surgery Physician
  • Loma Linda, CA
  • NPI 1275582918
  NPD (past)
• Loma Linda University Children's Hospital

  • Children's Hospital
  • Loma Linda, CA
  • NPI 1366866345
  NPD (past)
• Loma Linda University Medical Center

  • General Acute Care Hospital
  • Loma Linda, CA
  • NPI 1194731935
  NPD (past)

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

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1053637694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11406 LOMA LINDA DR STE 226",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543711",
            "telephone_number": "909-558-6644",
            "fax_number": "909-558-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25455 BARTON RD STE 102B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543139",
            "telephone_number": "909-558-6444",
            "fax_number": "909-558-6118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 N Graham St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271682",
            "country_code": "US",
            "telephone_number": "503-413-4488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "COREY",
        "middle_name": "BRANDON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-07",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A118405",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "OR",
            "license": "MD229227",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "A118405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Armen Karo Fstkchian, PHARMD
• Fuentes Family Counseling, Inc.
• Jose L Fuentes, PH.D
• Scott Thomas Fujimoto, D.O.
• Ashley Fukuchi, PHARMD
• Jennifer Carroll Fuller
• Juliana Noel Fuller, NP
• Robert Edward Fuller, PHYSICAL THERAPIET
• Melissa Jean Fulton, R.D.
• Jessica Colleen Fung, DO, MPH

• Sports Medicine (Orthopaedic Surgery) Physician in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.