NPIMap

Individual provider Active NPI

Russell Fullerton, MD

  • Diagnostic Radiology Physician
  • Milton, MA
National Provider Identifier
1255727228
Registry record updated May 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
287107 Issued in MA
Practice address
199 Reedsdale Rd
Milton, MA 02186-3926
Phone
(617) 696-4600
NPI assigned
Apr 7, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 287107 MA Primary

Addresses

Primary practice location

199 Reedsdale Rd
Milton, MA 02186-3926

Mailing address

790 Boylston St Apt 6G
Boston, MA 02199-7905
Phone (407) 446-1246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210615002318 MA Practitioner - Diagnostic Radiology 8921408857 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Florida Atlantic University, College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Physicians of Harvard Medical Faculty Physicians at Beth IsGroup PAC ID 6305749987, shared by 7 NPIs, 566 clinicians

Practice addresses (Care Compare)

100 Walter J Hannon Pkwy
Quincy, MA 02169-1105

101 Page St
New Bedford, MA 02740-3464
Phone (781) 983-9088

199 Reedsdale Rd
Milton, MA 02186-3926

275 Sandwich St
Plymouth, MA 02360-2183

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
267107MAMDInternal Medicine Physician
287107MAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Ce Diagnostic Radiology CurrentSince Jul 1, 2021 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Sep 1, 2025 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is Diagnostic Radiology CurrentSince Jul 1, 2021 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Jul 1, 2021 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Jul 1, 2021 Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

199 Reedsdale Rd
Milton, MA 02186
Phone (617) 313-1000

101 Page St
New Bedford, MA 02740
Phone (508) 961-5425

275 Sandwich St
Plymouth, MA 02360
Phone (508) 746-2000

Interoperability endpoints

  • Direct secure messaging: rfullerton252273@direct.bilh.masshiway.net

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.

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "created_epoch": "1428364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653177600000",
    "number": "1255727228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 BOYLSTON ST APT 6G",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021997905",
            "telephone_number": "407-446-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 REEDSDALE RD",
            "city": "MILTON",
            "state": "MA",
            "postal_code": "021863926",
            "telephone_number": "617-696-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "RUSSELL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-07",
        "last_updated": "2022-05-22",
        "certification_date": "2022-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "287107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milton, MA

Sources for this page

Verify at the official NPI Registry.