NPIMap

Individual provider Active NPI

Jayme Fuller, PA-C

  • Surgical Physician Assistant
  • Anchorage, AK
National Provider Identifier
1306490446
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
170490 Issued in AK
Practice address
4100 Lake Otis Pkwy Ste 108
Anchorage, AK 99508-5230
Phone
(907) 563-3145
Fax
(833) 464-5196
NPI assigned
Jul 26, 2019
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 170490 AK Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

4100 Lake Otis Pkwy Ste 108
Anchorage, AK 99508-5230

Mailing address

4100 Lake Otis Pkwy Ste 108
Anchorage, AK 99508-5230
Phone (907) 563-3145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210316000635 AK Practitioner - Physician Assistant 1153737226 Reassigns benefits to 2 organizations
I20250102000211 TX Practitioner - Physician Assistant 1153737226 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3900 Ambassador Dr
Anchorage, AK 99508-5922
Phone (907) 563-2662

4315 Diplomacy Dr
Anchorage, AK 99508-5926
Phone (907) 563-2662

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.93 of 100Reported as group
Quality
70.1
Promoting interoperability
100
Improvement activities
40
Cost
83.01

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Anchorage Fracture and Orthopaedic Clinic, PC CurrentSince Jan 11, 2020 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Nov 11, 2024 Accepting new patients
Medical Network of Alaska, LLC Current Accepting new patients
Medical Network of Alaska, LLC CurrentSince Mar 1, 2023 Accepting new patients
Anchorage Fracture and Orthopaedic Clinic, PC CurrentSince Jan 11, 2020 Accepting new patients
Medical Network of Alaska, LLC CurrentSince Mar 1, 2023 Accepting new patients

Locations

12350 Industry Way
Ste 110
Anchorage, AK 99515
Phone (907) 206-9114

3831 Piper St
Ste 220
Anchorage, AK 99508

4000 Ambassador Dr
Anchorage, AK 99508
Phone (907) 729-1900

4100 Lake Otis Pkwy
Ste 108
Anchorage, AK 99508
Phone (907) 339-2455

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

3122 E Meridian Park Loop
Wasilla, AK 99654
Phone (907) 864-4625

3331 E Meridian Park Loop
Wasilla, AK 99654
Phone (907) 357-2332

Organizations & group practices 7

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1306490446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 LAKE OTIS PKWY STE 108",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085230",
            "telephone_number": "907-563-3145",
            "fax_number": "833-464-5196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE OTIS PKWY STE 108",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085230",
            "telephone_number": "907-563-3145",
            "fax_number": "833-464-5196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JAYME",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-26",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AK",
            "license": "170490",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.