Mark Avery Fuller, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1901-320 Issued in WI

Practice address

36745 Aiken Rd
Bayfield, WI 54814-4579

Phone

(715) 779-3707

Fax

(715) 779-3362

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Dr. Mark Avery Moore-Fuller Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Practice

Education

Michigan State University College of Human Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Red Cliff Band of Lake Superior Chippewa IndiansGroup PAC ID 4284537580, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tamarack Health Ashland Medical Center Hospital, Ashland, WI, CCN 521359

Merit-based Incentive Payment System (MIPS)

Final score

86.19 of 100Reported as group

Quality

74.89

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Red Cliff Band of Lake Superior Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Bayfield, WI
  • NPI 1497744015

  WI

  Medicare reassignment Care Compare group NPD
• Red Cliff Band of Lake Superior Chippewa Indians

  • Land Ambulance
  • Bayfield, WI
  • NPI 1174672844
  NPD

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

• Memorial Medical Center Inc

  • Critical Access Hospital
  • Ashland, WI
  • NPI 1437179231

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1124055561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "638 LAKE AVE",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499381424",
            "telephone_number": "906-364-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36745 AIKEN RD",
            "city": "BAYFIELD",
            "state": "WI",
            "postal_code": "548144579",
            "telephone_number": "715-779-3707",
            "fax_number": "715-779-3362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MARK",
        "middle_name": "AVERY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "4301093004",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "1901-320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3536500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARK",
            "last_name": "MOORE-FULLER",
            "middle_name": "AVERY",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bayfield School District
• Christopher Daniel Boyd Sr., SAC
• Patrick Dean Brown, DDS
• Connected Mind and Body Therapy LLC
• Joseph L Corbine, LPC, SAC, CSIT
• Jacob P Geisler, MSW
• Martin A Gordon
• Isabel Georgiane Gregersen, LCSW
• Melissa Grooms, MS
• Nicole Renee Gurnoe

• All providers in Bayfield, WI
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.