NPIMap

Individual provider Active NPI

Breanne Fuller, PA-C

  • Physician Assistant
  • Hudson, NY
National Provider Identifier
1295101731
Registry record updated Mar 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018825 Issued in NY
Practice address
71 Prospect Ave
Hudson, NY 12534-2907
Phone
(518) 791-9482
NPI assigned
Aug 19, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2018

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 018825 NY Primary

Addresses

Primary practice location

71 Prospect Ave
Hudson, NY 12534-2907

Mailing address

31 Brookside Dr
Saratoga Springs, NY 12866-6303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150928001158 NY Practitioner - Physician Assistant 4880902659 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbia Memorial HospitalGroup PAC ID 5092709410, 171 clinicians

Practice addresses (Care Compare)

10 Grandview Ave
Catskill, NY 12414-2010
Phone (518) 828-7601

2827 US Route 9
Valatie, NY 12184-0785
Phone (518) 828-8051

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.78 of 100Reported as group
Quality
77.53
Promoting interoperability
100
Improvement activities
40
Cost
76.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018825NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College Physician Assistant Current Accepting new patients
Albany Medical College CurrentSince Jul 1, 2023 Accepting new patients
Albany Medical College Physician Assistant CurrentSince Jul 1, 2023 Accepting new patients
Columbia Memorial Hospital CurrentSince Feb 28, 2016 Accepting new patients
Columbia Memorial Hospital CurrentSince Feb 28, 2016 Accepting new patients

Locations

43 New Scotland Ave
#139
Albany, NY 12208
Phone (518) 262-3131

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

71 Prospect Ave
Hudson, NY 12534
Phone (518) 262-3773

117 Marys Ave
Ste 202
Kingston, NY 12401
Phone (845) 338-1717

365 Broadway
Kingston, NY 12401
Phone (845) 331-5165

1275 Broadway
#106
Menands, NY 12204
Phone (518) 262-9705

2827 US Highway 9
Valatie, NY 12184
Phone (518) 828-7601

Interoperability endpoints

  • Direct secure messaging: bfuller98523@albanymed.direct-ci.com

Organizations & group practices 9

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 6

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": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521158400000",
    "number": "1295101731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 BROOKSIDE DR",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "128666303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 PROSPECT AVE",
            "city": "HUDSON",
            "state": "NY",
            "postal_code": "125342907",
            "telephone_number": "518-791-9482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "BREANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-19",
        "last_updated": "2018-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudson, NY

Sources for this page

Verify at the official NPI Registry.