Desiree Starr Fuller, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

350713 Issued in NY

Practice address

1575 Washington St
Watertown, NY 13601-9371

Phone

(315) 785-4155

Fax

(315) 779-5066

NPI assigned

Nov 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samaritan Medical Center 157 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Samaritan Medical Center Hospital, Watertown, NY, CCN 330157

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: desiree.fuller@sfhcny.eclinicaldirectplus.com
• Direct secure messaging: dfuller@watertownpeds.medentdirect.com

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.

• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745

  Multi-Specialty, NY

  Medicare reassignment Care Compare group NPD
• Samaritan Medical Center

  • Rehabilitation Hospital Unit
  • Watertown, NY
  • NPI 1093722068
  Care Compare group NPD
• Samaritan Medical Center

  • Community/Retail Pharmacy
  • Watertown, NY
  • NPI 1447051305
  Care Compare group
• Pediatric Wellness of Northern New York

  • Pediatrics Physician
  • Watertown, NY
  • NPI 1982389854
  NPD (past)
• Samaritan Home Health Inc

  • Home Health Agency
  • Watertown, NY
  • NPI 1487057576
  NPD (past)
• Watertown Pediatrics,PC

  • Specialist
  • Watertown, NY
  • NPI 1750318705

  Multi-Specialty

  NPD (past)

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

• Samaritan Medical Center

  • General Acute Care Hospital
  • Watertown, NY
  • NPI 1598713745

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1093423352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136019371",
            "telephone_number": "315-785-4155",
            "fax_number": "315-779-5066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136019371",
            "telephone_number": "315-785-4155",
            "fax_number": "315-779-5066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1571 Washington St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "NY",
            "postal_code": "136019304",
            "country_code": "US",
            "telephone_number": "315-782-7330",
            "fax_number": "315-782-5773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "DESIREE",
        "middle_name": "STARR",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-07",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "350713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYSED OP",
            "identifier": "350713",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Ann Frith, DO
• Robin D Frost, RPA-C
• Amanda Frostad, LCSW
• Elizabeth Lauren Fry, LMSW
• Ping Fu, M.D.
• Samantha Jo Furman, NP
• Melinda Gabriel, LICENSED MARRIAGE AN
• Mary Ellen Gagnon, LPN
• Elisabeth Gahler, PT
• Robin D Gaines, R.N.

• All providers in Watertown, NY
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; 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.