Justin Scott Fuller, PA
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Madras, OR
NPI 1609767227 · NPPES record last updated Apr 16, 2026
Key facts
- NPI
- 1609767227
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 470 NE a St
Madras, OR 97741-1844 - Phone
- (541) 475-4800
- Fax
- (541) 475-4805
- NPI assigned
- Jul 11, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2500 NE Neff Rd
Bend, OR 97701-6015
PO Box
Bend, OR 97708
PO Box
Suite 6095
Bend, OR 97708-6095
Hospital & facility affiliations
- St Charles Madras
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251215001856 | OR | Practitioner - Physician Assistant | 3971097114 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Charles Health System, Inc. | Current |
Accepting new patients | |
| St. Charles Health System, Inc. | Current |
Accepting new patients | |
| St. Charles Health System, Inc. | Current |
Accepting new patients | |
| St. Charles Health System, Inc. | Current |
Accepting new patients | |
| St. Charles Health System, Inc. | Current |
Accepting new patients |
Locations
29358 Network Pl
Chicago, IL 60673
470 NE A St
Madras, OR 97741
Phone (541) 383-3668
480 NE A St
Madras, OR 97741
Phone (541) 475-4800
384 SE Combs Flat Rd
Prineville, OR 97754
Phone (541) 383-3668
211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164
1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131
Interoperability endpoints
- jfuller225951@secure.stcharleshealthcare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
470 NE a St
Madras, OR 97741-1844
Mailing address
4311 11TH Ave NE Ste 200
Seattle, WA 98105-6367
Other practice location 1
4311 11th Ave NE Ste 200
Seattle, WA 98105-6367
Phone (206) 616-4001
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jfuller225951@secure.stcharleshealthcare.org |
Other providers in Madras, OR
- Rachel Lynn Fiocchi
- Robbin Webber Foster
- Candace Rose Frantz
- Fresenius Medical Care Dialysis Services - Oregon, LLC
- Kortney Fritts
- Lydia Trujillo Galan
- Aldo Garcia
- Jimmy Garcia
- Melinda Garcia
- Gary Dehm, DMD
All providers in Madras, OR · Student in an Organized Health Care Education/Training Program in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.