NPIMap

Individual provider Active NPI

Keith Lyle Fuller, D.O.

  • Family Medicine Physician
  • Opelika, AL
National Provider Identifier
1730125527
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO350 Issued in AL
Practice address
2214 Gateway Dr
Suite C
Opelika, AL 36801-1500
Phone
(334) 741-0075
Fax
(334) 741-4075
NPI assigned
Jun 21, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 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 DO350 AL Primary

Addresses

Primary practice location

2214 Gateway Dr
Suite C
Opelika, AL 36801-1500

Mailing address

2214 Gateway Dr
Suite C
Opelika, AL 36801-1500
Phone (334) 741-0075

Other identifiers 3

IdentifierTypeStateIssuer
DO350OtherALMEDICAL LICENSE
000026574MedicaidAL
51026574OtherALBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20051128000429 AL Practitioner - Family Practice 9335100148 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Alabama Family Practice, P.C.Group PAC ID 3173584976, 5 clinicians

Practice addresses (Care Compare)

2214 Gateway Dr C
Opelika, AL 36801-6832
Phone (334) 741-0075

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.72 of 100Reported as individual
Quality
84.79
Promoting interoperability
96
Improvement activities
40
Cost
76.28

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO350ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regencell of East Alabama, LLC CurrentSince May 9, 2024 Accepting new patients
The East Alabama Health Care Authority Past Accepting new patients
Arbor Lake Health & Rehab, LLC Past Accepting new patients
Arbor Springs Health and Rehab Center, LTD Past Accepting new patients
Randolph Management Company, Inc. Past Accepting new patients
Parkwood Health Care Facility, LLC Past Accepting new patients

Locations

2214 Gateway Dr
Ste C
Opelika, AL 36801
Phone (334) 741-0075

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14759/brand/1/csg/1/fhir/r4
  • Direct secure messaging: keith.fuller.1@14759.direct.athenahealth.com

Organizations & group practices 7

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1730125527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 GATEWAY DR",
            "address_2": "SUITE C",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368011500",
            "telephone_number": "334-741-0075",
            "fax_number": "334-741-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2214 GATEWAY DR",
            "address_2": "SUITE C",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368011500",
            "telephone_number": "334-741-0075",
            "fax_number": "334-741-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KEITH",
        "middle_name": "LYLE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "DO350",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000026574",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51026574",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Opelika, AL

Sources for this page

Verify at the official NPI Registry.