NPIMap

Individual provider Active NPI

Keith A Fuller, MD

  • Internal Medicine Physician
  • Cleveland, OH
National Provider Identifier
1720015977
Registry record updated May 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35057294F Issued in OH
Practice address
9500 Euclid Ave
Cleveland, OH 44195-0001
Phone
(800) 223-2273
NPI assigned
Jun 26, 2006
Last updated
May 19, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35057294F OH Primary

Addresses

Primary practice location

9500 Euclid Ave
Cleveland, OH 44195-0001

Mailing address

6000 W Creek Rd
Ste 10
Independence, OH 44131-2139
Phone (800) 223-2273

Other identifiers 1

IdentifierTypeStateIssuer
2447972MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20040614000217 OH Practitioner - Internal Medicine 7517941123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Northeastern Ohio University College of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

26900 Cedar Rd
Beachwood, OH 44122-1191
Phone (216) 839-3000

29800 Bainbridge Rd
Solon, OH 44139-2202
Phone (216) 444-6568

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35057294FOHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Euclid Hospital Cleveland Clinic Health System Current Accepting new patients
The Cleveland Clinic Foundation CurrentSince Jun 1, 2004 Accepting new patients

Locations

8254 Mayfield Rd
Chesterland, OH 44026
Phone (440) 729-0100

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6000 W Creek Rd
Ste 10
Independence, OH 44131
Phone (216) 986-1256

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

29800 Bainbridge Rd
Solon, OH 44139
Phone (440) 519-6800

Interoperability endpoints

  • Direct secure messaging: kfullermd59021@direct.ccf.org

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211155200000",
    "number": "1720015977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 W CREEK RD",
            "address_2": "STE 10",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312139",
            "telephone_number": "800-223-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950001",
            "telephone_number": "800-223-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KEITH",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2008-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35057294F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2447972",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.