Jordan Fuller, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

OS15231 Issued in FL

Practice address

61 Dolphin Dr
Treasure Island, FL 33706-3113

Phone

(727) 853-1701

NPI assigned

Jun 9, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

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 2

Specialty

Internal Medicine

Education

Lake Erie College of Osteopathic Medicine, Erie, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Bayside Medical Group LLCGroup PAC ID 9931325990, 8 clinicians

Lakeland Regional Health Systems IncGroup PAC ID 8325952914, 513 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baycare Home Care Inc Home health agency, Largo, FL, CCN 107212
• St Anthonys Hospital Hospital, Saint Petersburg, FL, CCN 100067
• Lakeland Regional Medical Center Hospital, Lakeland, FL, CCN 100157
• Morton Plant Hospital Hospital, Clearwater, FL, CCN 100127

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Bayside Medical Group LLC

  • Hospitalist Physician
  • Treasure Island, FL
  • NPI 1215353818
  Medicare reassignment Care Compare group NPD
• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1497748743
  Medicare reassignment Care Compare group NPD
• Hospital Medicine Services of FL, LLC

  • Hospitalist Physician
  • Aventura, FL
  • NPI 1710684857
  Medicare reassignment NPD
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  Medicare reassignment NPD

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

• Baycare Home Care, Inc.

  • Home Health Agency
  • Largo, FL
  • NPI 1033117007
  Care Compare affiliation
• Lakeland Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Lakeland, FL
  • NPI 1144228446
  Care Compare affiliation
• Morton Plant Hospital Association Inc

  • General Acute Care Hospital
  • Clearwater, FL
  • NPI 1376529743
  Care Compare affiliation
• St. Anthonys Hospital, Inc.

  • General Acute Care Hospital
  • St Petersburg, FL
  • NPI 1427024942
  Care Compare affiliation

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1679922678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 DOLPHIN DR",
            "city": "TREASURE ISLAND",
            "state": "FL",
            "postal_code": "337063113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 DOLPHIN DR",
            "city": "TREASURE ISLAND",
            "state": "FL",
            "postal_code": "337063113",
            "telephone_number": "727-853-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JORDAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-09",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS15231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elite Assessments
• Elite Health Assessments
• Karlee Fisher
• Footprints Beachside Recovery
• Footprints Beachside Recovery Inc
• Julie Gardner
• Herbert Gersh, MD
• Mamoon Ali Ghellai, MBBCH
• Linda Karen Gibbons, ARNP
• Amanda Gibson

• Internal Medicine Physician in Treasure Island, FL
• Providers in Treasure Island, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.