Kristle M Fullerton

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

802 Baltimore Pike
Bel Air, MD 21014-4212

Phone

(443) 643-2422

NPI assigned

Feb 7, 2019

Sex

Female

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 MD

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 Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Premier Wellness HealthcareGroup PAC ID 1052688389, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Harford Crisis Center, Inc.

  • Psychiatry Physician
  • Bel Air, MD
  • NPI 1508334459
  Medicare reassignment NPD
• Premier Wellness Healthcare

  • Clinical Psychologist
  • Forest Hill, MD
  • NPI 1376087635
  NPD
• Premier Wellness Healthcare

  • Mental Health Counselor
  • Fawn Grove, PA
  • NPI 1922554401
  NPD (past)

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

{
    "created_epoch": "1549497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549497600000",
    "number": "1124583729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 BALTIMORE PIKE",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144212",
            "telephone_number": "443-643-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 BALTIMORE PIKE",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144212",
            "telephone_number": "443-643-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "KRISTLE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-07",
        "last_updated": "2019-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alec Lorenzo Frezza, DDS
• Melissa Karayinopulos Frickmann
• Jennifer Lyn Fritsch, M.A., BCBA, LBA
• Kelly D Fritz, MS
• Debora Frost
• Caitlin Anne Furman, LCPC
• Theresa Gacheny, COTA
• Doreen F Gagne, NP
• Laura C Gajec, PHARMD
• Kristina Anna Gambrell, RN, BSN,IBCLC

• Clinical Social Worker in Bel Air, MD
• Providers in Bel Air, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2019; 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.