Active NPI
Peggy A Fuller, MD
- Specialist
- Charlotte, NC
National Provider Identifier
1598871345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 9700555
- Practice address
- 353 Clement Ave
Charlotte, NC 28204-2431 - Phone
- (704) 370-2700
- Fax
- (704) 370-2702
- NPI assigned
- Aug 22, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 9700555 | NC | Primary |
Addresses
Primary practice location
353 Clement Ave
Charlotte, NC 28204-2431
Mailing address
353 Clement Ave
Charlotte, NC 28204-2431
Phone (704) 370-2700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9700555 | Other | NC | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 2, 2017 through Oct 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9700555 | NC | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Esthetics Center for Dermatology PA | Specialist | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JFBCDA/Endpoint/JFBCDA
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.
-
- Specialist
- Charlotte, NC
- NPI 1891879615
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598871345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "353 CLEMENT AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282042431",
"telephone_number": "704-370-2700",
"fax_number": "704-370-2702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "353 CLEMENT AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282042431",
"telephone_number": "704-370-2700",
"fax_number": "704-370-2702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "PEGGY",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "9700555",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "9700555",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.