Active NPI
Brianna Katherine Fuller, PA
- Physician Assistant
- Hudson, NY
National Provider Identifier
1215137591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 012528
- Practice address
- 71 Prospect Avenue
Hudson, NY 12534 - Phone
- (518) 758-6101
- NPI assigned
- Jul 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 012528 | NY | Primary |
Addresses
Primary practice location
71 Prospect Avenue
Hudson, NY 12534
Mailing address
71 Prospect Ave
Hudson, NY 12534-2907
Phone (518) 758-6101
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012528 | Other | NY | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012528 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New York Oncology Hematology PC | Current | Accepting new patients | |
| Integrative Medical Associates of New York, PLLC | Past | Accepting new patients |
Locations
896 Riverview Rd
Rexford, NY 12148
Phone (518) 399-4600
Organizations & group practices 5
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.
-
- General Practice Physician
- Bohemia, NY
- NPI 1871965855
-
- Hematology & Oncology Physician
- Albany, NY
- NPI 1609863448
-
- Non-Pharmacy Dispensing Site
- Albany, NY
- NPI 1326466244
-
- Family Medicine Physician
- Delmar, NY
- NPI 1518261163
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552953600000",
"number": "1215137591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 PROSPECT AVE",
"city": "HUDSON",
"state": "NY",
"postal_code": "125342907",
"telephone_number": "518-758-6101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 PROSPECT AVENUE",
"city": "HUDSON",
"state": "NY",
"postal_code": "12534",
"telephone_number": "518-758-6101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "BRIANNA",
"middle_name": "KATHERINE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-24",
"last_updated": "2019-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012528",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "012528",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hudson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.