Individual provider Active NPI

Courtney R Fuller, PA-C

  • Physician Assistant
  • Raynham, MA
National Provider Identifier
1265944227
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA6288 Issued in MA
Practice address
675 Paramount Dr Ste 205
Raynham, MA 02767-5416
Phone
(617) 798-6500
Fax
(617) 798-6500
NPI assigned
Oct 31, 2017
Last updated
Mar 21, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA6288 MA Primary

Addresses

Primary practice location

675 Paramount Dr Ste 205
Raynham, MA 02767-5416

Mailing address

675 Paramount Dr Ste 205
Raynham, MA 02767-5416
Phone (508) 996-3991

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180118002218 MA Practitioner - Physician Assistant 6002175130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

300 B Faunce Corner Rd
Suite 101
North Dartmouth, MA 02747-1257
Phone (508) 973-1020

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. Current Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Oct 30, 2025 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Oct 30, 2025 Accepting new patients

Locations

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

300B Faunce Corner Rd
#101
North Dartmouth, MA 02747
Phone (508) 973-1020

300B Faunce Corner Rd
#103
North Dartmouth, MA 02747

Interoperability endpoints

  • Direct secure messaging: cfuller88779@direct.southcoast.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1509408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1265944227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 PARAMOUNT DR STE 205",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "027675416",
            "telephone_number": "508-996-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 PARAMOUNT DR STE 205",
            "city": "RAYNHAM",
            "state": "MA",
            "postal_code": "027675416",
            "telephone_number": "617-798-6500",
            "fax_number": "617-798-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "COURTNEY",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-31",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raynham, MA

Sources for this page

Verify at the official NPI Registry.