Individual provider Active NPI

Colleen D. Fullerton, NP

  • Family Nurse Practitioner
  • Providence, RI
National Provider Identifier
1528139730
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
37214 Issued in RI
Practice address
33 Staniford St
Providence, RI 02905-3105
Phone
(401) 421-8800
Fax
(401) 273-6510
NPI assigned
Nov 10, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 37214 RI Primary

Addresses

Primary practice location

33 Staniford St
Providence, RI 02905-3105

Mailing address

33 Staniford St
Providence, RI 02905-3105
Phone (401) 421-8800

Other identifiers 2

IdentifierTypeStateIssuer
9003157MedicaidRI
CF54829MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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

Enrollment IDStateProvider typePAC IDDetails
I20040202000961 RI Practitioner - Nurse Practitioner 7517850803 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Gastroenterology, LLCGroup PAC ID 3678762804, 99 clinicians

Practice addresses (Care Compare)

33 Staniford St
Providence, RI 02905-3105
Phone (401) 421-8800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
37214RIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Gastroenterology, LLC CurrentSince Oct 10, 2014 Accepting new patients

Locations

33 Staniford St
Providence, RI 02905
Phone (401) 274-1810

Organizations & group practices 1

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1528139730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 STANIFORD ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053105",
            "telephone_number": "401-421-8800",
            "fax_number": "401-273-6510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 STANIFORD ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053105",
            "telephone_number": "401-421-8800",
            "fax_number": "401-273-6510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "COLLEEN",
        "middle_name": "D.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "RI",
            "license": "37214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9003157",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CF54829",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.