NPIMap

Individual provider Active NPI

Chad Fuller, MD

  • Family Medicine Physician
  • San Luis Obispo, CA
National Provider Identifier
1679062632
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A174124 Issued in CA
Practice address
1250 Peach St Ste a
San Luis Obispo, CA 93401-2871
Phone
(805) 543-4043
Fax
(805) 543-7640
NPI assigned
May 5, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A174124 CA Primary

Addresses

Primary practice location

1250 Peach St Ste a
San Luis Obispo, CA 93401-2871

Mailing address

1250 Peach St Ste a
San Luis Obispo, CA 93401-2871
Phone (805) 543-4043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210827001726 CA Practitioner - Family Practice 4688079775 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
David B. HammerGroup PAC ID 3971559881, 117 clinicians

Practice addresses (Care Compare)

1051 Las Tablas Rd
Templeton, CA 93465-5603

1250 Peach St
Suite a
San Luis Obispo, CA 93401-2871
Phone (805) 543-4043

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.64 of 100Reported as apm
Quality
86.27
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions20
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A174124CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Central Coast Health Centers CurrentSince Sep 13, 2021 Accepting new patients
Pacific Central Coast Health Centers CurrentSince Sep 13, 2021 Accepting new patients
Pacific Central Coast Health Centers Current Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients

Locations

1510 E Main St
Ste 104C
Santa Maria, CA 93454
Phone (805) 349-8514

117 W Bunny Ave
Santa Maria, CA 93458
Phone (805) 739-3474

1250 Peach St
Ste A
Sn Luis Obisp, CA 93401
Phone (805) 543-4043

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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.

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": "1525478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1679062632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 PEACH ST STE A",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012871",
            "telephone_number": "805-543-4043",
            "fax_number": "805-543-7640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 PEACH ST STE A",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012871",
            "telephone_number": "805-543-4043",
            "fax_number": "805-543-7640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "CHAD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-05",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A174124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.