NPIMap

Individual provider Active NPI

Brian G. Fuller, M.D.

  • Radiation Oncology Physician
  • Coos Bay, OR
National Provider Identifier
1396834412
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
MD186291 Issued in OR
Practice address
1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone
(541) 269-8520
Fax
(541) 267-5083
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 49432 CO
Radiation Oncology Physician 2085R0001X MD186291 OR Primary
Radiation Oncology Physician 2085R0001X MD2023-0362 NM

Addresses

Primary practice location

1775 Thompson Rd
Coos Bay, OR 97420-2125

Mailing address

1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone (541) 269-8520

Other practice location 1

801 W Maple St
Farmington, NM 87401-5630
Phone (505) 609-6259

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20240106000745 NM Practitioner - Radiation Oncology 0749289643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of California, Geffen School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Juan Regional Medical Center, Inc.Group PAC ID 4587559505, 233 clinicians

Practice addresses (Care Compare)

801 W Maple St
San Juan Regional Hospitalist
Farmington, NM 87401-5630
Phone (505) 609-6463

Hospital & facility affiliations

  • San Juan Regional Medical Center Inc Hospital, Farmington, NM, CCN 320005
  • Northern Navajo Medical Center Hospital, Shiprock, NM, CCN 320059

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49432COMDRadiation Oncology Physician
MD186291ORMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Juan Regional Medical Center Inc CurrentSince Nov 27, 2023 Accepting new patients
San Juan Regional Medical Center Inc CurrentSince Nov 27, 2023 Accepting new patients
San Juan Regional Medical Center Inc Current Accepting new patients
Central Virginia Radiation Oncologists P C Radiation Oncology Past Accepting new patients
University of Virginia Physicians Group PastSince Nov 1, 2017 Accepting new patients
University of California Irvine Past Accepting new patients

Locations

801 W Maple St
Farmington, NM 87401
Phone (505) 325-5011

4820 E Main St
Ste 2
Farmington, NM 87402
Phone (505) 609-6610

Organizations & group practices 6

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 7

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1396834412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202125",
            "telephone_number": "541-269-8520",
            "fax_number": "541-267-5083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 THOMPSON RD",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202125",
            "telephone_number": "541-269-8520",
            "fax_number": "541-267-5083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 W Maple St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "NM",
            "postal_code": "874015630",
            "country_code": "US",
            "telephone_number": "505-609-6259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "BRIAN",
        "middle_name": "G.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CO",
            "license": "49432",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "OR",
            "license": "MD186291",
            "primary": true
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NM",
            "license": "MD2023-0362",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coos Bay, OR

Sources for this page

Verify at the official NPI Registry.