Traci Ann Fuller, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

50003781 Issued in OH

Practice address

6480 Harrison Ave
Suite 100
Cincinnati, OH 45247-7961

Phone

(513) 354-3700

Fax

(513) 354-7651

NPI assigned

Aug 31, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Traci Ann Fuller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Beacon Orthopaedics & Sports Medicine, LTD

  • Specialist
  • Cincinnati, OH
  • NPI 1386670065
  NPD (past)
• Effingham Hospital, Inc.

  • Otolaryngology Physician
  • Springfield, GA
  • NPI 1881588028
  NPD (past)

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1487961231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6480 HARRISON AVE",
            "address_2": "SUITE 100",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452477961",
            "telephone_number": "513-354-3700",
            "fax_number": "513-354-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6480 HARRISON AVE",
            "address_2": "SUITE 100",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452477961",
            "telephone_number": "513-354-3700",
            "fax_number": "513-354-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TRACI",
        "middle_name": "ANN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-31",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "006385",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "006385",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50003781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "50003781",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "006385",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACI",
            "last_name": "FULLER",
            "middle_name": "ANN",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hadley Lauren Fuller I
• Jayla Evonne Fuller
• Leah Fuller, PHARMD, RPH
• Michael Fuller
• Nancy M Fuller
• Tyler Allen Fuller, D.O.
• Denise Suzanne Fulmer, RN
• Jessica Anne Fulmer, PTA
• Erin Turner Fulton, CRNA
• Jill Fulton, OTR/L

• Surgical Physician Assistant in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Surgical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; 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.