Matthew Gerald Fuller

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6062 Issued in TN

Practice address

3601 The Vanderbilt Clinic
Nashville, TN 37232-5428

Phone

(615) 936-2000

NPI assigned

May 3, 2019

Last updated

Jul 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA, OR, CO3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Stellar Clinic CT PLLCGroup PAC ID 0840633368, 46 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mfuller730668@direct.vumc.org

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.

• Stellar Clinic CT PLLC

  • Mental Health Counselor
  • Detroit, MI
  • NPI 1609641042

  CO, VA

  Medicare reassignment Care Compare group NPD
• Linda Kay Berlingen, LPC

  • Professional Counselor
  • Portland, OR
  • NPI 1184862955
  Medicare reassignment
• Rose City Therapists LLC

  • Professional Counselor
  • Portland, OR
  • NPI 1366036840
  NPD (past)

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

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1750946950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 COUNTY ROAD 110 N",
            "city": "MOUND",
            "state": "MN",
            "postal_code": "553648338",
            "telephone_number": "386-795-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 THE VANDERBILT CLINIC",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372325428",
            "telephone_number": "615-936-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7101 York Ave S Ste 357",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554354428",
            "country_code": "US",
            "telephone_number": "970-926-6340",
            "fax_number": "970-926-6348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MATTHEW",
        "middle_name": "GERALD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-03",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3369",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH18270",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "6062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mfuller730668@direct.vumc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health Information Service Provider",
            "address_1": "3601 The Vanderbilt Clinic",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372325428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Madeline Ashton Fullbright Cross, RN
• Fuller Home Health Care LLC
• Ambrea Monique Fuller
• Kristen Michelle Fuller, APRN
• Ma'Rion Fuller, DMD
• Torri Fuller, PHARMD
• Fullerton Medical Clinic, PLLC
• Fullerton Medical Group
• Randy Curtis Fullerton, M.D.
• Fullfillment Tender Care, Inc.

• Mental Health Counselor in Nashville, TN
• Providers in Nashville, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.