Individual provider Active NPI

Madisen Fuller, LCSW

  • Clinical Social Worker
  • Cape Coral, FL
National Provider Identifier
1093534901
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW23805 Issued in FL
Practice address
418 SW 47TH Ter
Cape Coral, FL 33914-6506
Phone
(239) 690-6906
NPI assigned
Oct 8, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X SW23805 FL Primary

Addresses

Primary practice location

418 SW 47TH Ter
Cape Coral, FL 33914-6506

Mailing address

16713 Demi Dr
Athens, AL 35613-6217

Other names 1

  • Madisen Reece Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241119002070 FL Practitioner - Clinical Social Worker 8022543792 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dna Comprehensive Therapy Services LLCGroup PAC ID 2860619632, 446 clinicians

Practice addresses (Care Compare)

2721 Del Prado Blvd S
Suite 200
Cape Coral, FL 33904-5783
Phone (239) 673-9034

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SW23805FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bonita Springs Retirement Village, Inc. CurrentSince Nov 5, 2024 Accepting new patients
Dna Comprehensive Therapy Services, LLC Clinical CurrentSince Nov 5, 2024 Accepting new patients

Locations

418 SW 47th Ter
Cape Coral, FL 33914
Phone (239) 673-9034

2721 Del Prado Blvd S
Ste 200
Cape Coral, FL 33904
Phone (239) 458-6677

4310 Metro Pkwy
Ste 205
Fort Myers, FL 33916

3191 Harbor Blvd
Ste A
Pt Charlotte, FL 33952
Phone (941) 766-9555

5825 Argerian Dr
Ste 101
Wesley Chapel, FL 33545
Phone (813) 687-4870

Interoperability endpoints

  • Direct secure messaging: madisen.fuller.1@13142.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1093534901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16713 DEMI DR",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356136217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 SW 47TH TER",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339146506",
            "telephone_number": "239-690-6906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MADISEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW23805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADISEN",
            "last_name": "REECE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cape Coral, FL

Sources for this page

Verify at the official NPI Registry.