Mark A Fuller

Primary specialty

TaxiTaxonomy code 344600000X

Practice address

2215 W Willow Knolls Drive
Apt 503a
Peoria, IL 61614-1446

Phone

(217) 330-0928

NPI assigned

Jul 25, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417470147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 W WILLOW KNOLLS DR APT 503A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141446",
            "telephone_number": "217-330-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 W WILLOW KNOLLS DRIVE",
            "address_2": "APT 503A",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141446",
            "telephone_number": "217-330-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MARK",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "344600000X",
            "taxonomy_group": "",
            "desc": "Taxi",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82-2237856",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James R. Frost, D.D.S.
• Shellie Frost, LCPC
• Sarah Frye
• Full Circle Counseling and Wellness, LLC
• Brianna Fullenkamp, PT, DPT
• Sarah Fuller, P,T,
• Laura Marie Fullerton, APN
• Morgan Ann Fulton-Gorham, LCSW
• Emerick Fulton
• Ryan Timothy Funk, M.D.

• Taxi in Peoria, IL
• Providers in Peoria, IL by specialty
• Taxi in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.