Timothy Louis Fuller, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

1343 Issued in TN

Practice address

428 East Vann Road
Greeneville, TN 37743-7202

Phone

(423) 278-1950

Fax

(423) 278-1973

NPI assigned

Nov 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Blue Ridge Medical Management Corporation

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833

  TN

  Medicare reassignment NPD
• Blue Ridge Medical Management Corporation

  • Neurological Surgery Physician
  • Johnson City, TN
  • NPI 1003152307
  NPD
• Blue Ridge Medical Management Corporation

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Blue Ridge Medical Management Corporation

  • Cardiovascular Disease Physician
  • Johnson City, TN
  • NPI 1740227131
  NPD (past)
• Takoma Regional Hospital Inc

  • General Acute Care Hospital
  • Greeneville, TN
  • NPI 1699819003
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1497822845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15004",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "37901",
            "telephone_number": "865-522-9730",
            "fax_number": "865-637-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 EAST VANN ROAD",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377437202",
            "telephone_number": "423-278-1950",
            "fax_number": "423-278-1973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "TIMOTHY",
        "middle_name": "LOUIS",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "1343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4121421",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JD",
            "identifier": "TN01Q1",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frontier Health
• Frontier Health
• Frontier Health
• Stephanie Ann Frost, DC
• James Jeffery Fuller, RRT
• Christina Rochelle Gaby, FNP
• Erin Colleen Gaby, MSOT, OTR/L
• Melissa Gaffney, DPM
• James Walter Gamble Jr., D.M.D.
• Zachary Gamble, DO

• Pediatrics Physician in Greeneville, TN
• Providers in Greeneville, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.