Clark Beeman Fuller, M.D.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

G76647 Issued in CA

Practice address

8635 W 3Rd St
Suite 975W
Los Angeles, CA 90048-6101

Phone

(310) 652-0530

Fax

(310) 652-9936

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Thoracic Surgery

Education

Creighton University School of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cedars-Sinai Medical Care FoundationGroup PAC ID 0941106645, 1,684 clinicians

Cedars-Sinai Medical CenterGroup PAC ID 0446169114, 788 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cedars-Sinai Medical Center Hospital, Los Angeles, CA, CCN 050625
• Torrance Memorial Medical Center Hospital, Torrance, CA, CCN 050351

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: cfuller102741@direct.cshs.org

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.

• Cedars-Sinai Medical Care Foundation

  • Specialist
  • Los Angeles, CA
  • NPI 1316984388
  Medicare reassignment Care Compare group NPD
• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1639172372
  Medicare reassignment Care Compare group NPD
• Torrance Memorial Medical Center

  • Diagnostic Radiology Physician
  • Torrance, CA
  • NPI 1477502797
  Medicare reassignment NPD
• Cedars-Sinai Medical Center

  dba San Vicente Pharmacy

  • Pharmacy
  • Los Angeles, CA
  • NPI 1376514810
  NPD
• Torrance Memorial Medical Center

  • Skilled Nursing Facility
  • Torrance, CA
  • NPI 1740268713
  NPD
• Pasadena Hospital Association, LTD.

  dba Huntington Hospital

  • Psychiatric Hospital Unit
  • Pasadena, CA
  • NPI 1437121142
  NPD (past)
• Usc Cardiothoracic Surgeon'S

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Los Angeles, CA
  • NPI 1457364507
  NPD (past)
• Usc University Hospital, Inc.

  dba USC Hospital

  • Psychiatric Hospital Unit
  • Los Angeles, CA
  • NPI 1790718500
  NPD (past)

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

• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1639172372
  Care Compare affiliation
• Cedars-Sinai Medical Center

  • General Acute Care Hospital
  • West Hollywood, CA
  • NPI 1891940326
  Care Compare affiliation
• Torrance Memorial Medical Center

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1467459776
  Care Compare affiliation

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1790890341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8635 W 3RD ST",
            "address_2": "SUITE 975W",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900486101",
            "telephone_number": "310-652-0530",
            "fax_number": "310-652-9936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8635 W 3RD ST",
            "address_2": "SUITE 975W",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900486101",
            "telephone_number": "310-652-0530",
            "fax_number": "310-652-9936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "CLARK",
        "middle_name": "BEEMAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "G76647",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G76647",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Belen Camacho Fuller, MSW
• Brent Fuller, ASW
• Catherine G Fuller, M.D.
• Christina Fuller
• Claire V. Fuller, MD
• David Lee Fuller II, M.D.
• Deborah Fuller, MA
• Jack G. Fuller, PA-C
• Jennifer Elizabeth Fuller, PT
• Laura Marie Fuller, MFT INTERN

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; 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.