Active NPI
Brian C Fuller, D.O.
- Cardiovascular Disease Physician
- Flagstaff, AZ
National Provider Identifier
1174608772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 3196
- Practice address
- 2000 S Thompson St
Flagstaff, AZ 86001-8759 - Phone
- (928) 226-6400
- Fax
- (928) 226-6411
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 3196 | AZ | |
| Cardiovascular Disease Physician | 207RC0000X | 3196 | AZ | Primary |
Addresses
Primary practice location
2000 S Thompson St
Flagstaff, AZ 86001-8759
Mailing address
2000 S Thompson St
Flagstaff, AZ 86001-8759
Phone (928) 226-6400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 387953 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3196 | AZ | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospitalists of Arizona, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Hospitalist Physician
- Phoenix, AZ
- NPI 1508194036
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238371200000",
"number": "1174608772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 S THOMPSON ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860018759",
"telephone_number": "928-226-6400",
"fax_number": "928-226-6411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 S THOMPSON ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860018759",
"telephone_number": "928-226-6400",
"fax_number": "928-226-6411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "BRIAN",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2009-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "AZ",
"license": "3196",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "AZ",
"license": "3196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "387953",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.