Bryan Carroll Fuller, CPO

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

1298 Issued in DE

Practice address

612 Rio Rd W Ste 5
Charlottesville, VA 22901-1412

Phone

(434) 529-8882

Fax

(434) 529-8882

NPI assigned

Sep 12, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Fuller'S Orthopedic

  • Prosthetist
  • Fishersville, VA
  • NPI 1164294948
  NPD Authorized official
• Fuller'S Orthopedic

  • Prosthetic/Orthotic Supplier
  • Charlottesville, VA
  • NPI 1215362850
  NPD Authorized official

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

{
    "created_epoch": "1378944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1487089124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 RIO RD W STE 5",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229011412",
            "telephone_number": "434-529-8882",
            "fax_number": "434-529-8942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 RIO RD W STE 5",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229011412",
            "telephone_number": "434-529-8882",
            "fax_number": "434-529-8882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W 12th St",
            "address_purpose": "LOCATION",
            "city": "Waynesboro",
            "state": "VA",
            "postal_code": "229804771",
            "country_code": "US",
            "telephone_number": "540-949-9089",
            "fax_number": "540-949-9089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "BRYAN",
        "middle_name": "CARROLL",
        "name_prefix": "Mr.",
        "credential": "CPO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-09-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "DE",
            "license": "1298",
            "primary": false
        },
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "DE",
            "license": "1298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215362850",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angelica Marie Fuentes, MD, MS
• Lois W. Fulks, N.P.
• Full Life PC
• Full Stride Providers
• Benjamin Fuller
• Corene S Fuller, PA
• Renee Ann Fuller, OT
• Robert R Fuller, MD
• Fuller'S Orthopedic
• Olivia Fulton, OT

• Orthotist in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Orthotist in Virginia

• 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.