Active NPI
Jonalyn Pascua Fuller, NP
- Gerontology Nurse Practitioner
- Springfield, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 2021043723
- Practice address
- 2115 S Fremont Ave Ste 3300
Springfield, MO 65804-2246 - Phone
- (417) 820-5200
- NPI assigned
- Dec 8, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2015021422 | MO | |
| Gerontology Nurse Practitioner | 363LG0600X | 2021043723 | MO | Primary |
Addresses
Primary practice location
2115 S Fremont Ave Ste 3300
Springfield, MO 65804-2246
Mailing address
2115 S Fremont Ave Ste 3300
Springfield, MO 65804-2246
Phone (417) 820-5200
Other practice location 1
1501 N Oakland Ave
Bolivar, MO 65613-3020
Phone (417) 326-7200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Springfield Communities
Practice addresses (Care Compare)
2115 S Fremont Ave
3300 MC Gastroenterology Whiteside
Springfield, MO 65804-2246
Phone (417) 820-5200
448 State Hwy 248
Suite 160
Branson, MO 65616-3725
Phone (417) 213-4696
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015021422 | MO | MD | Registered Nurse |
| 2021043723 | MO | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Signify Health, LLC | Nurse Practitioner | Current | Accepting new patients |
Locations
448 State Highway 248
Ste 160
Branson, MO 65616
Phone (417) 213-4696
2300 Main St
Fl 9
Kansas City, MO 64108
Phone (800) 416-1767
1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379
1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115
2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905
2115 S Fremont Ave
Ste 3300
Springfield, MO 65804
Phone (417) 820-5200
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Interoperability endpoints
- jonalyn.fuller@cccancer.ikm.direct-ci.com
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Springfield, MO
- NPI 1245277631
-
- Rural Health Clinic/Center
- Willow Springs, MO
- NPI 1972771657
-
- Family Medicine Physician
- Hollister, MO
- NPI 1053350454
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Springfield, MO
- NPI 1578504056
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665360000000",
"number": "1457010381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2115 S FREMONT AVE STE 3300",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042246",
"telephone_number": "417-820-5200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2115 S FREMONT AVE STE 3300",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042246",
"telephone_number": "417-820-5200"
}
],
"practiceLocations": [
{
"address_1": "1501 N Oakland Ave",
"address_purpose": "LOCATION",
"city": "Bolivar",
"state": "MO",
"postal_code": "656133020",
"country_code": "US",
"telephone_number": "417-326-7200",
"fax_number": "417-326-7201",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FULLER",
"first_name": "JONALYN",
"middle_name": "PASCUA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-08",
"last_updated": "2022-10-10",
"certification_date": "2022-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MO",
"license": "2015021422",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MO",
"license": "2021043723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; 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.