Kevin S Fuller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110001208 Issued in VA

Practice address

13135 Lee Jackson Memorial Hwy Ste 305
Fairfax, VA 22033-1907

Phone

(703) 359-8640

Fax

(703) 591-6105

NPI assigned

Jun 30, 2008

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Merit-based Incentive Payment System (MIPS)

Final score

83.36 of 100Reported as group

Quality

73.03

Promoting interoperability

100

Improvement activities

40

Cost

71.49

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Inova Health Care Services

  • Multi-Specialty Clinic/Center
  • Fairfax, VA
  • NPI 1669511051
  NPD

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1417119652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37174",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212973174",
            "telephone_number": "571-423-5699",
            "fax_number": "571-423-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13135 LEE JACKSON MEMORIAL HWY STE 305",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907",
            "telephone_number": "703-359-8640",
            "fax_number": "703-591-6105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3620 Joseph Siewick Dr",
            "address_2": "Suite 406",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220331756",
            "country_code": "US",
            "telephone_number": "703-359-8640",
            "fax_number": "703-259-6324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KEVIN",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "0110001208",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417119652",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Degache Landu Fukiau
• Emily Irene Fulbrook, PT, DPT, ATC
• Rosanna C Fulchiero, D.O.
• Fuling Clinic LLC
• Jennifer Fuller, LMFT
• Marcella Yvette Fulmore, MSW
• Kirsten Fulop
• Rebecca Fulp-Eickstaedt, CNS, LDN
• Jeffery Fulton, PSYCHOLOGIST
• Renee Elizabeth Funches, M.D.

• Physician Assistant in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.
• 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.