NPIMap

Individual provider Active NPI

Greg Richardson Fuller, DO

  • Family Medicine Physician
  • Chesapeake, VA
National Provider Identifier
1841815958
Registry record updated Nov 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102207938 Issued in VA
Practice address
1933 Edwin Dr Ste 208
Chesapeake, VA 23322-6531
Phone
(757) 252-5820
NPI assigned
Jun 15, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X LL83280 SC
Family Medicine Physician 207Q00000X 0102207938 VA Primary

Addresses

Primary practice location

1933 Edwin Dr Ste 208
Chesapeake, VA 23322-6531

Mailing address

1933 Edwin Dr Ste 208
Chesapeake, VA 23322-6531
Phone (757) 252-5820

Other practice location 1

853 N Church St Ste 510
Spartanburg, SC 29303-3077
Phone (864) 560-6193

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20230914001465 VA Practitioner - Family Practice 3971928706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

1933 Edwin Dr
Suite 208
Chesapeake, VA 23322-6531
Phone (757) 252-5820

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0102207938VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Medical Group Family Medicine CurrentSince Aug 7, 2023 Accepting new patients

Locations

1933 Edwin Dr
Ste 208
Chesapeake, VA 23322
Phone (757) 252-5820

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

Interoperability endpoints

  • Direct secure messaging: gfuller846033@direct.sentara.net

Organizations & group practices 1

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.

Hospital & facility affiliations 9

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": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700524800000",
    "number": "1841815958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 EDWIN DR STE 208",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233226531",
            "telephone_number": "757-252-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 EDWIN DR STE 208",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233226531",
            "telephone_number": "757-252-5820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "853 N Church St Ste 510",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293033077",
            "country_code": "US",
            "telephone_number": "864-560-6193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "GREG",
        "middle_name": "RICHARDSON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-15",
        "last_updated": "2023-11-21",
        "certification_date": "2023-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL83280",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102207938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.