Jeremy Wayne Fuller, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95015009 Issued in CA

Practice address

220 Concourse Blvd
Santa Rosa, CA 95403-8210

Phone

(844) 527-7369

NPI assigned

Dec 22, 2020

Last updated

Feb 24, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Evolve Restorative CenterGroup PAC ID 0840553715, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Santa Rosa Memorial Hospital Hospital, Santa Rosa, CA, CCN 050174
• Sutter Santa Rosa Regional Hospital Hospital, Santa Rosa, CA, CCN 050291
• Healdsburg Hospital Hospital, Healdsburg, CA, CCN 051321

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jfuller732536@hisp.ehr.sutterhealth.org

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.

• Evolve Restorative Center

  • Interventional Pain Medicine Physician
  • Santa Rosa, CA
  • NPI 1215437249
  Medicare reassignment Care Compare group NPD
• Hill Country Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1457844318
  NPD (past)

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

• Norcal Healthconnect LLC

  • Multi-Specialty Clinic/Center
  • Healdsburg, CA
  • NPI 1720695547

  Hospital

  Care Compare affiliation
• Norcal Healthconnect LLC

  dba Healdsburg Hospital

  • Critical Access Hospital
  • Healdsburg, CA
  • NPI 1861009672
  Care Compare affiliation
• St. Joseph Health Northern California, LLC

  dba Providence Santa Rosa Memorial Hospital

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  Care Compare affiliation
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  Care Compare affiliation

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1285221440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 CONCOURSE BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038210",
            "telephone_number": "844-527-7369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 CONCOURSE BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038210",
            "telephone_number": "844-527-7369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JEREMY",
        "middle_name": "WAYNE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-22",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95015009",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95015009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen P Fuette, MD
• David Henry Fughum, RAS
• Ken Fujii, MD
• Quinn Tetsuro Fujii, DO
• Ashley Ann Fukumae
• Andy Leroy Fulton Jr., RAS
• Linda G Funderburg, M.D.
• Esther Auxiliadora Funez Castro
• Yen Mey Fung, PHARM.D.
• Heather Jean Furnas, MD

• Family Nurse Practitioner in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; 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.