NPIMap

Individual provider Active NPI

Philip Tod Fuller, PA-C, MMS, BS, EMT-P

  • Surgical Physician Assistant
  • Aurora, CO
National Provider Identifier
1447403209
Registry record updated Oct 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2697 Issued in CO
Practice address
1411 S Potomac St
Suite 400
Aurora, CO 80012-4536
Phone
(303) 695-6060
Fax
(303) 369-7776
NPI assigned
Oct 24, 2008
Last updated
Oct 24, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 2697 CO Primary

Addresses

Primary practice location

1411 S Potomac St
Suite 400
Aurora, CO 80012-4536

Mailing address

1411 S Potomac St
Suite 400
Aurora, CO 80012-4536
Phone (303) 695-6060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20090212000562 CO Practitioner - Physician Assistant 1850456575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthone Heart Care LLCGroup PAC ID 9436394467, 48 clinicians

Practice addresses (Care Compare)

1444 S Potomac St
300 Aurora Denver Cardiology Associates
Aurora, CO 80012-4510
Phone (303) 750-0822

1444 S Potomac St
Suite 310
Aurora, CO 80012-4508
Phone (303) 750-0822

1501 S Potomac St
The Medical Centers of Aurora
Aurora, CO 80012-5411
Phone (303) 695-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.9 of 100Reported as group
Quality
73.94
Promoting interoperability
99
Improvement activities
40
Cost
75.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science, Emergency Medical Technician - Paramedic, Physician Assistant

State licenses

LicenseStateTypeSpecialty
2697COMDSurgical Physician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1224806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224806400000",
    "number": "1447403209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 S POTOMAC ST",
            "address_2": "SUITE 400",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124536",
            "telephone_number": "303-695-6060",
            "fax_number": "303-369-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 S POTOMAC ST",
            "address_2": "SUITE 400",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800124536",
            "telephone_number": "303-695-6060",
            "fax_number": "303-369-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "PHILIP",
        "middle_name": "TOD",
        "name_prefix": "Mr.",
        "credential": "PA-C, MMS, BS, EMT-P",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-24",
        "last_updated": "2008-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "2697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.