Erinn C Fuller, PA-C
Individual provider Active NPI Physician Assistant · Granger, IN
NPI 1295058717 · NPPES record last updated Sep 17, 2025
Key facts
- NPI
- 1295058717
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10001520A (IN)
- Practice address
- 3221 Beacon Parkway
Granger, IN 46530-7196 - Phone
- (574) 647-1670
- Fax
- (574) 647-6927
- NPI assigned
- Mar 11, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Beacon Medical Group Inc
Practice addresses (Care Compare)
100 Navarre PL
South Bend, IN 46601-1171
3220 Beacon Pkwy
Granger, IN 46530-7196
Phone (574) 999-8838
3221 Beacon Pkwy
Granger, IN 46530-7196
Phone (574) 647-1670
615 N Michigan St
South Bend, IN 46601-1033
615 N Michigan St FL
South Bend, IN 46601-1033
6913 N Main St
Granger, IN 46530-8039
Hospital & facility affiliations
- Memorial Hospital of South Bend
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130827000815 | IN | Practitioner - Physician Assistant | 3274660105 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10001520A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Medical Group, Inc. | Physician Assistant | Current | Accepting new patients |
| Beacon Medical Group Inc | Current |
Accepting new patients | |
| Beacon Medical Group, Inc. | Past | Accepting new patients |
Locations
1020 High Rd
Bremen, IN 46506
Phone (574) 309-9967
6913 N Main St
Granger, IN 46530
Phone (574) 647-1500
3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129
3221 Beacon Pkwy
Granger, IN 46530
Phone (574) 647-1670
900 I St
Laporte, IN 46350
Phone (219) 324-1670
111 W Jefferson Blvd
Ste 100
South Bend, IN 46601
Phone (574) 647-1669
100 Navarre Pl
Ste 4440
South Bend, IN 46601
Phone (574) 647-4540
1815 E Ireland Rd
South Bend, IN 46614
Phone (574) 647-1700
100 Navarre Pl
Ste 4470
South Bend, IN 46601
Phone (574) 647-1300
710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610
621 Memorial Dr
Ste 302
South Bend, IN 46601
Phone (574) 236-1888
615 N Michigan St
Fl 1
South Bend, IN 46601
Phone (574) 647-1100
Interoperability endpoints
- erinnfuller@beacon.allscriptsdirect.net
- fuller@mybeacon.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10001520A | IN | Yes |
Addresses
Primary practice location
3221 Beacon Parkway
Granger, IN 46530-7196
Mailing address
3245 Health Dr Ste 100
Granger, IN 46530-1380
Phone (574) 647-2129
Other practice location 1
100 Navarre Pl Ste 4470
South Bend, IN 46601-1168
Phone (574) 367-3800
Other practice location 2
100 Navarre Pl Ste 4440
South Bend, IN 46601-1171
Phone (574) 647-5300
Other practice location 3
1815 E Ireland Rd
South Bend, IN 46614-2845
Phone (574) 647-1700
Other practice location 4
621 Memorial Dr Ste 302
South Bend, IN 46601-1073
Phone (574) 367-3800
Other practice location 5
111 W Jefferson Blvd Ste 100
South Bend, IN 46601-1993
Phone (574) 647-1670
Other practice location 6
1020 High Rd
Bremen, IN 46506-1093
Phone (574) 309-9967
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300005961 | Medicaid | IN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | FULLER@mybeacon.cernerdirect.com |
Other providers in Granger, IN
- Tracy Ford
- Tina Lyn Foster
- Lauren Freet
- Lorraine Frey
- Monica Fryska
- Michael Ross Futa
- Edward Fynn
- Tracey Lee Gangluff
- Dena Nichole Garnett
- Shondalin A Gates
All providers in Granger, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.