Jordan S Fuller, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301019267 Issued in MI

Practice address

3011 Baltimore Ave
Kansas City, MO 64108-3403

Phone

(159) 874-6836

NPI assigned

Aug 17, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Clinical Psychologist

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ability KCGroup PAC ID 0143116368, 166 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Ability KC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Kansas City, MO
  • NPI 1598746836
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1093598484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17751 WEXFORD ST",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664629",
            "telephone_number": "913-449-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 BALTIMORE AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641083403",
            "telephone_number": "159-874-6836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JORDAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301019267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joy Marie Fulbright, M.D.
• Arlene Jean Fulcher, RT (R)(CT)
• Danielle Fulks
• David Frederick Fuller, M.D.
• Gabe Fuller
• Robert Wayne Fuller Jr., LMT
• Katelynn S Fullmer, PLPC
• Nikcola Fulton
• Rachel Fulton
• Function Forward Physical Therapy LLC

• Psychologist in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 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.
• 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.