Carissa Sharnetta Fuller, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

SP009193 Issued in PA

Practice address

3401 N Broad St
Philadelphia, PA 19140-5103

Phone

(215) 707-1800

Fax

(215) 707-3644

NPI assigned

Apr 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ecu Health Medical Center Hospital, Greenville, NC, CCN 340040
• Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

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.

• Main Line Healthcare

  • Family Medicine Physician
  • Newtown Square, PA
  • NPI 1922077643
  Medicare reassignment Care Compare group NPD
• Vidant Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Greenville, NC
  • NPI 1477648731
  Medicare reassignment Care Compare group NPD
• Prospect Health Access Network, Inc.

  • Emergency Medicine Physician
  • Chester, PA
  • NPI 1568819084
  Medicare reassignment NPD
• Temple Faculty Practice Plan Inc

  • Anesthesiology Physician
  • Philadelphia, PA
  • NPI 1881176949
  Medicare reassignment NPD
• University of Penn - Medical Group

  • Cardiovascular Disease Physician
  • Philadelphia, PA
  • NPI 1093725145
  Medicare reassignment NPD
• University of Penn - Medical Group

  • Geriatric Medicine (Internal Medicine) Physician
  • Philadelphia, PA
  • NPI 1497767495
  Medicare reassignment NPD
• University of Penn - Medical Group

  • Endocrinology, Diabetes & Metabolism Physician
  • Philadelphia, PA
  • NPI 1568579266
  Medicare reassignment NPD
• University of Penn-Medical Group

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1477658599
  Medicare reassignment NPD
• Prospect Health Access Network, Inc.

  • Diagnostic Radiology Physician
  • Chester, PA
  • NPI 1154776797
  NPD
• Prospect Health Access Network, Inc.

  • Endocrinology, Diabetes & Metabolism Physician
  • Springfield, PA
  • NPI 1871948414
  NPD
• Temple Faculty Practice Plan, Inc

  • Pediatrics Physician
  • Philadelphia, PA
  • NPI 1932682671
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD

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

• Main Line Hospitals, Inc.

  • General Acute Care Hospital
  • Wynnewood, PA
  • NPI 1245335629
  Care Compare affiliation
• Pitt County Memorial Hospital Inc

  • General Acute Care Hospital
  • Washington, NC
  • NPI 1780359687
  Care Compare affiliation
• Pitt County Memorial Hospital, Inc

  • General Acute Care Hospital
  • Greenville, NC
  • NPI 1043218944
  Care Compare affiliation

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1407070501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 N BROAD ST RM 1A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404106",
            "telephone_number": "215-926-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191405103",
            "telephone_number": "215-707-1800",
            "fax_number": "215-707-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "CARISSA",
        "middle_name": "SHARNETTA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "DE",
            "license": "LP0000308",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP009193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Fulds
• Haley Fulforth, AU.D
• Alyssa Grace Fulginiti, DO
• Full Circle Care LLC
• Full Circle Nutrition Therapy LLC
• Collin Guthrie Fuller, M.D.
• David B Fuller, D.O.
• Joshua Fuller
• Karrianne Marie Fuller
• Megan Fuller, M.D.

• Adult Health Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Adult Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.