NPIMap

Individual provider Active NPI

Timothy Fuller, MD

  • Vascular Surgery Physician
  • Tifton, GA
National Provider Identifier
1104153063
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
085351 Issued in GA
Practice address
1641 Madison Ave
Tifton, GA 31794-3757
Phone
(229) 353-2284
NPI assigned
Nov 12, 2009
Last updated
Jan 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MED-PHYS-LIC-103773 MT
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X 085351 GA
Vascular Surgery Physician 2086S0129X 085351 GA Primary
Vascular Surgery Physician 2086S0129X MED-PHYS-LIC-103773 MT

Addresses

Primary practice location

1641 Madison Ave
Tifton, GA 31794-3757

Mailing address

907 18TH St E Ste 400
Tifton, GA 31794-3684
Phone (229) 353-3422

Other practice location 1

1333 Surgical Services Way
Kalispell, MT 59901-4844
Phone (406) 751-5392

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address timothy.fuller@trhs.cernerdirect.com
Direct Messaging Address DEPTLHRevIntegrityHIMTechs@logan.org Kalispell Regional Medical Center, Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, MT, CO3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20200617000951 GA Practitioner - Vascular Surgery 5092137224 Reassigns benefits to 1 organization
I20220105001993 MT Practitioner - Vascular SurgeryPractitioner - General Surgery 5092137224 Reassigns benefits to 1 organization
I20240318001152 CO Practitioner - Vascular Surgery 5092137224 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Mercer University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

1641 Madison Ave
Tifton, GA 31794-3757
Phone (229) 535-2285

1800 15TH St
Greeley, CO 80631-4562

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121

4700 Lady Moon Dr
Fort Collins, CO 80528-4426

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-103773MTMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tift Regional Health System Inc CurrentSince Aug 3, 2020 Accepting new patients
Banner Health Physicians Colorado LLC Current Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Feb 8, 2024 Accepting new patients
Tift Regional Health System Inc Vascular Surgery Current Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Apr 1, 2024 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Tift Regional Health System Inc CurrentSince Aug 3, 2020 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Apr 1, 2024 Accepting new patients
Tift Regional Health System Inc Current Accepting new patients
Banner Health Physicians Colorado LLC Past Accepting new patients

Locations

1800 15th St
Ste 220
Greeley, CO 80631
Phone (970) 353-1335

1800 15th St
Ste 340
Greeley, CO 80631
Phone (970) 351-6044

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

260 Mj Taylor Rd
Adel, GA 31620
Phone (229) 247-2290

1641 Madison Ave
Tifton, GA 31794
Phone (229) 353-2284

2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

907 18th St E
Ste 400
Tifton, GA 31794

1333 Surgical Services Way
Kalispell, MT 59901
Phone (406) 751-5392

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

Interoperability endpoints

  • Direct secure messaging: timothy.fuller@trhs.cernerdirect.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1104153063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E STE 400",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943684",
            "telephone_number": "229-353-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 MADISON AVE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943757",
            "telephone_number": "229-353-2284"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1333 Surgical Services Way",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599014844",
            "country_code": "US",
            "telephone_number": "406-751-5392",
            "fax_number": "406-751-5406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-12",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MT",
            "license": "MED-PHYS-LIC-103773",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "085351",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "085351",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MT",
            "license": "MED-PHYS-LIC-103773",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "timothy.fuller@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1641 Madison Ave",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317943757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DEPTLHRevIntegrityHIMTechs@logan.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center, Inc",
            "address_1": "1333 Surgical Services Way",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599014844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.