Lisa L Fuller, M.D.

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

33576 Issued in AZ

Practice address

4315 E Main St
Mesa, AZ 85205-8605

Phone

(480) 870-7500

Fax

(480) 906-2173

NPI assigned

Mar 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Practice roles

Locations

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.

• Archwell Health Professional Services of Arizona, LLC

  • Internal Medicine Physician
  • Mesa, AZ
  • NPI 1558026880
  Medicare reassignment NPD
• Memphis Regional Planned Parenthood

  • Ambulatory Family Planning Facility
  • Memphis, TN
  • NPI 1538366471
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1366567398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 E MAIN ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852058605",
            "telephone_number": "480-870-7500",
            "fax_number": "480-906-2173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720 W Southern Ave",
            "address_2": "Suite B1-B6",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852024834",
            "country_code": "US",
            "telephone_number": "615-778-4066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "LISA",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "AZ",
            "license": "33576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aurelia Fuller, OTRL
• Charmaine Fuller
• Jessica Fuller, RBT
• Justin Wayne Fuller
• Kisti Pope Fuller, MD
• Nina L Fuller
• Rex Dustin Fuller, DC
• Rosemary Fuller, R.N.
• Tecla Fuller, DC
• Zaria Fuller, RBT

• Occupational Medicine Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Occupational Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; 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.