Emily N Fuller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-02470 Issued in KS

Practice address

3533 Southern Blvd Ste 5650
Kettering, OH 45429-1263

Phone

(937) 294-3611

Fax

(937) 294-9010

NPI assigned

Apr 7, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in KS, UT, OH3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cotton-O'Neil Clinic Revocable TrustGroup PAC ID 5496659195, 659 clinicians

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stormont Vail Hospital Hospital, Topeka, KS, CCN 170086
• Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: efuller673197@direct.med.utah.edu
• Direct secure messaging: efuller107354@stormontvaildirect.org

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.

• Cotton-O'Neil Clinic Revocable Trust

  • Internal Medicine Physician
  • Topeka, KS
  • NPI 1811944457
  Medicare reassignment Care Compare group NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group
• University of Utah Adult Services

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1114321981
  Medicare reassignment Care Compare group
• Cotton-O'Neil Clinic Revocable Trust

  • Durable Medical Equipment & Medical Supplies
  • Topeka, KS
  • NPI 1700076015
  NPD
• University of Utah Adult Services

  • Neurology Physician
  • Salt Lake City, UT
  • NPI 1578967345
  NPD
• University of Utah Adult Services

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
  • NPI 1598169419
  NPD
• Bronson Lakeview Hospital

  • Internal Medicine Physician
  • Paw Paw, MI
  • NPI 1235131137
  NPD (past)

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

• Kettering Medical Center

  • General Acute Care Hospital
  • Kettering, OH
  • NPI 1043233984
  Care Compare affiliation
• Stormont-Vail Healthcare Inc

  • General Acute Care Hospital
  • Topeka, KS
  • NPI 1194782409
  Care Compare affiliation

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1194354506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 SW 10TH AVE",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666041301",
            "telephone_number": "785-354-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD STE 5650",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291263",
            "telephone_number": "937-294-3611",
            "fax_number": "937-294-9010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 W Grand Ave Ste 2002",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454054722",
            "country_code": "US",
            "telephone_number": "379-294-3611",
            "fax_number": "937-294-9010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 SW 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Topeka",
            "state": "KS",
            "postal_code": "666041301",
            "country_code": "US",
            "telephone_number": "785-354-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "EMILY",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-07",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-02470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efuller107354@stormontvaildirect.org",
            "affiliation": "Y",
            "endpointDescription": "SVH Secure messaging",
            "affiliationName": "COTTON O'NEIL CLINIC REVOCABLE TRUST",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "830 SW Mulvane St",
            "city": "Topeka",
            "state": "KS",
            "country_code": "US",
            "postal_code": "666061654",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efuller673197@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efuller107354@stormontvaildirect.org",
            "affiliation": "Y",
            "endpointDescription": "SVH Secure Messaging",
            "affiliationName": "STORMONT-VAIL HEALTHCARE INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "830 SW Mulvane St",
            "city": "Topeka",
            "state": "KS",
            "country_code": "US",
            "postal_code": "666061654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physician Assistant in Kettering, OH
• Providers in Kettering, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; 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.