Chuck B Fuller, PA-C
Individual provider Active NPI Physician Assistant · Twin Falls, ID
NPI 1124015102 · NPPES record last updated Jan 10, 2008
Key facts
- NPI
- 1124015102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA-499 (ID)
- Practice address
- 660 Shoshone St E
Suite 130
Twin Falls, ID 83301-6110 - Phone
- (208) 732-3400
- Fax
- (208) 732-3300
- NPI assigned
- Oct 4, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 13
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sterling Provider Group
Practice addresses (Care Compare)
1404 Pomerelle Ave
Suite A1
Burley, ID 83318-2013
Phone (208) 878-8783
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041203000151 | ID | Practitioner - Physician Assistant | 5698731479 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Falls Avenue Immediate Care PA | Current |
Accepting new patients | |
| Psychiatric Services, PA | Past | Accepting new patients | |
| Psychiatric Services Behavioral Health Clinic Inc | Past | Accepting new patients | |
| Page Family Medicine | Past | Accepting new patients | |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Locations
260 Falls Ave
Ste D
Twin Falls, ID 83301
Phone (208) 733-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-499 | ID | Yes |
Addresses
Primary practice location
660 Shoshone St E
Suite 130
Twin Falls, ID 83301-6110
Mailing address
660 Shoshone St E
Suite 130
Twin Falls, ID 83301-6110
Phone (208) 732-3400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010147741 | Other | ID | REGENCE BLUE SHIELD IND # |
| PAQR4 | Other | ID | BLUE CROSS IND # |
Other providers in Twin Falls, ID
- Sonia Fry
- Barbara Jane Fuchs
- Daniel Scott Fuchs
- Edward L Fuchs
- Brooke Marie-Osgood Fukuoka
- Jennie Rebecca Fullmer
- Shawna Fultz
- Chase A Funk
- Spencer Funk
- G Adrian Dean MD Inc
All providers in Twin Falls, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.