Mary Fuller, DNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209021513 Issued in IL

Practice address

110 N Burr Blvd
Kewanee, IL 61443-2214

Phone

(309) 852-0197

Fax

(309) 854-5575

NPI assigned

Jul 29, 2020

Last updated

Aug 4, 2020By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of HenryGroup PAC ID 5193828556, 5 clinicians

Advanced Physical Therapy Services, LTD.Group PAC ID 9133101462, shared by 5 NPIs, 216 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Saint Luke Medical Center Hospital, Kewanee, IL, CCN 141325

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Henry

  dba First Choice Healthcare

  • State or Local Public Health Clinic/Center
  • Kewanee, IL
  • NPI 1851394829
  Medicare reassignment Care Compare group NPD
• County of Henry

  dba First Choice Healthcare

  • Rural Health Clinic/Center
  • Toulon, IL
  • NPI 1245049501
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Osf Healthcare System

  dba Osf Saint Luke Medical Center

  • Critical Access Hospital
  • Kewanee, IL
  • NPI 1871919381
  Care Compare affiliation

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

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1497364053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N BURR BLVD",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614432214",
            "telephone_number": "309-852-0197",
            "fax_number": "309-854-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N BURR BLVD",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614432214",
            "telephone_number": "309-852-0197",
            "fax_number": "309-854-5575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-29",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209021513",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209021513",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "IL",
            "license": "209021513",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366006568001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sadie Jo Espino, M.S CF-SLP
• Guadalupe Favela
• Margaret Ann Feurer, NURSE PRACTITIONER
• Ashley Foglesong, OT
• Josefina Foreman
• Heather Gainey
• Philip Gambon, PT
• Dennis J Gerleman, DC
• Mary Kathleen Gordon, OTR/L
• Shamaila B Gorsi, M.D.

• Nurse Practitioner in Kewanee, IL
• Providers in Kewanee, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; 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.

Verify at the official NPI Registry.