Sam Fuller, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

01075560A Issued in IN

Practice address

53880 Carmichael Dr
South Bend, IN 46635-1567

Phone

(574) 247-9441

Fax

(574) 247-9442

NPI assigned

Apr 1, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Hand SurgeryAlso: Orthopedic Surgery, Plastic and Reconstructive Surgery

Education

University of Chicago, Pritzker School of Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Indiana Orthopedics LLCGroup PAC ID 5698667822, 148 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
• Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
• Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018

Merit-based Incentive Payment System (MIPS)

Final score

81.81 of 100Reported as group

Quality

64.48

Promoting interoperability

96

Improvement activities

40

Cost

78.21

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sfuller1161494@direct.trinity-health.org
• Direct secure messaging: sam.fuller.3@13070.direct.athenahealth.com
• Direct secure messaging: sfuller305179@dulyhealthandcare.direct-ci.com

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.

• Central Indiana Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Muncie, IN
  • NPI 1063422137
  Medicare reassignment Care Compare group NPD
• Allied Physicians Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • South Bend, IN
  • NPI 1386721249
  NPD
• Allied Physicians Surgery Center, LLC

  • Anesthesiology Physician
  • South Bend, IN
  • NPI 1669032942
  NPD
• Central Indiana Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Indianapolis, IN
  • NPI 1669207023
  NPD

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

• Elkhart General Hospital, Inc.

  • General Acute Care Hospital
  • Elkhart, IN
  • NPI 1477551489
  Care Compare affiliation
• Saint Joseph Regional Medical Center- Plymouth Campus Inc

  • General Acute Care Hospital
  • Plymouth, IN
  • NPI 1174571129
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

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

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725321600000",
    "number": "1649569484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 W BETHEL AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473045407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53880 CARMICHAEL DR",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351567",
            "telephone_number": "574-247-9441",
            "fax_number": "574-247-9442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60160 Bodnar Blvd",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465449338",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 S Nappanee St Ste F",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465142066",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2349 Lake Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "IN",
            "postal_code": "465637837",
            "country_code": "US",
            "telephone_number": "574-247-9441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "SAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-01",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0105X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgery of the Hand",
            "state": "IN",
            "license": "01075560A",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IN",
            "license": "01075560A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary B Fromm, MD
• Joseph Frye, MS
• Leslie Asher Fuchs, DPT
• Claudia Rose Fugate
• Daniel H Fulkerson, M.D.
• Tamara Ann Fuller, FNP-BC
• Erin Elsa Fund, MD
• William Owen Funston, LSW
• Jaclyn Ann Fusco
• Deepak N Gaba, MD

• Plastic and Reconstructive Surgery Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Plastic and Reconstructive Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.