Richard E Fuller, MD

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

32988-020 Issued in WI

Practice address

17780 Versailles CT
Brookfield, WI 53045-5026

Phone

(262) 389-1375

NPI assigned

Jun 17, 2005

Last updated

Jun 11, 2021By 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 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: richard.fuller.2@23284.direct.athenahealth.com

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.

• Rae Holdings, LTD

  dba Rejuvinix

  • Physical Medicine & Rehabilitation Physician
  • Brookfield, WI
  • NPI 1922574417
  Medicare reassignment NPD

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1306841002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17780 VERSAILLES CT",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455026",
            "telephone_number": "262-389-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17780 VERSAILLES CT",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455026",
            "telephone_number": "262-389-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "RICHARD",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-17",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "WI",
            "license": "32988-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208000000X",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31875900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1306841002",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Rae Frost, BCBA
• Kristin Fuchs
• Pamela Fuellemann, P.T.
• Riley Fugiasco, FNP-BC
• Kimball Sands Fuiks, MD
• Hallie J Fury
• Fusion Anesthesia Solutions, LTD
• Samuel Gable, PHD
• Karen Lee Gableman, PTA PHYSICAL THERAPI
• Jane Gabrielson

• Adult Medicine Physician in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Adult Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.