NPIMap

Individual provider Active NPI

Jeremy Alex Fuller, NP

  • Family Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1841821162
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
23635 Issued in SC
Practice address
6119 White Horse Rd Ste 14
Greenville, SC 29611-3838
Phone
(864) 614-7001
NPI assigned
Jan 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 23635 SC Primary

Addresses

Primary practice location

6119 White Horse Rd Ste 14
Greenville, SC 29611-3838

Mailing address

PO Box 740013
Atlanta, GA 30374-0013
Phone (312) 733-9730

Other practice location 1

300 W Butler Rd
Mauldin, SC 29662-2585
Phone (864) 991-9016 ext. 86499

Other practice location 2

1200 Woodruff Rd. Blg A3
Ste 196
Greenville, SC 29607
Phone (864) 301-6872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20200220000004 SC Practitioner - Nurse Practitioner 4082041660 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oak Street Health Physicians Group of South Carolina LLCGroup PAC ID 3375959075, 31 clinicians

Practice addresses (Care Compare)

6119 White Horse Rd
Suite 14
Greenville, SC 29611-3838
Phone (864) 614-7001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
23635SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health Physicians Group of South Carolina, LLC Family CurrentSince Aug 19, 2024 Accepting new patients
Palmetto Internal Medicine & Primary Care, PA CurrentSince Jan 28, 2020 Accepting new patients

Locations

6119 White Horse Rd
Ste 14
Greenville, SC 29611
Phone (864) 614-7001

300 W Butler Rd
Mauldin, SC 29662
Phone (864) 277-8300

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 and National Provider Directory roles.

Hospital & facility affiliations 50

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

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1841821162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740013",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303740013",
            "telephone_number": "312-733-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6119 WHITE HORSE RD STE 14",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296113838",
            "telephone_number": "864-614-7001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 W Butler Rd",
            "address_purpose": "LOCATION",
            "city": "Mauldin",
            "state": "SC",
            "postal_code": "296622585",
            "country_code": "US",
            "telephone_number": "864-991-9016 x86499",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Woodruff Rd. Blg A3",
            "address_2": "Ste 196",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "29607",
            "country_code": "US",
            "telephone_number": "864-301-6872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JEREMY",
        "middle_name": "ALEX",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-27",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "23635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.