Gregory W Fuller, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

5101012543 Issued in MI

Practice address

1006 Airport Rd
Jackson, MI 49202-1851

Phone

(517) 784-6663

Fax

(517) 787-7976

NPI assigned

Jun 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI, FL2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, 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.

• Degara App, PLLC

  • Emergency Medicine Physician
  • Lansing, MI
  • NPI 1265976971
  Medicare reassignment NPD
• Emergency Department Physicians, P.C.

  • Emergency Medicine Physician
  • Detroit, MI
  • NPI 1225083595
  Medicare reassignment NPD
• Observation Emergency Physicians, P.C.

  • Emergency Medicine Physician
  • Detroit, MI
  • NPI 1497920524
  Medicare reassignment NPD
• Sparrow Ionia Hospital

  • Critical Access Hospital
  • Ionia, MI
  • NPI 1700820065
  Medicare reassignment NPD
• Vituity - Michigan Em PC

  • Emergency Medicine Physician
  • Lansing, MI
  • NPI 1144892332
  Medicare reassignment NPD
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment NPD
• Sparrow Ionia Hospital

  • Family Medicine Physician
  • Ionia, MI
  • NPI 1033271143
  NPD
• Sparrow Ionia Hospital

  • Emergency Medicine Physician
  • Ionia, MI
  • NPI 1588747075
  NPD
• Bixby Hospital

  • Clinical Medical Laboratory
  • Adrian, MI
  • NPI 1407275696
  NPD (past)
• Calhoun County Emergency Physicians PC

  • Emergency Medicine Physician
  • Battle Creek, MI
  • NPI 1952585465
  NPD (past)
• Emma L. Bixby Medical Center

  • General Acute Care Hospital
  • Adrian, MI
  • NPI 1972564730
  NPD (past)
• Epmg of Michigan, P.C.

  • Emergency Medicine Physician
  • Livonia, MI
  • NPI 1386688992
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1174569107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 AIRPORT RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492021851",
            "telephone_number": "517-784-6663",
            "fax_number": "517-787-7976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 AIRPORT RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492021851",
            "telephone_number": "517-784-6663",
            "fax_number": "517-787-7976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "GREGORY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "012543",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS5478",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101012543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114545400",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "GF012543",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Fritch
• Kelcy Elizabeth Fritz, NP
• Kellie Fritz, RD
• Joni Frost, NP
• Julie Marie Frownfelder
• Jennifer Fuller
• Rachael Fuller
• Functional Health PC
• Alexis N Futrell
• G and R Felpausch Company

• Emergency Medicine Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.