Sam Eroni Fullman, MBBS

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

5063C Issued in AS

Practice address

Tafuna Health Center
Petesa Rd, Tafuna
Pago Pago, AS 96799

Phone

(684) 699-6380

NPI assigned

Oct 5, 2023

Last updated

Oct 5, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• American Samoa Medical Center

  • Internal Medicine Physician
  • Pago, AS
  • NPI 1043085681
  Medicare reassignment NPD

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

{
    "created_epoch": "1696464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1851171839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "TAFUNA HEALTH CENTER",
            "address_2": "PETESA RD, TAFUNA",
            "city": "PAGO PAGO",
            "state": "AS",
            "postal_code": "96799",
            "telephone_number": "684-699-6380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "TAFUNA HEALTH CENTER",
            "address_2": "PETESA RD, TAFUNA",
            "city": "PAGO PAGO",
            "state": "AS",
            "postal_code": "96799",
            "telephone_number": "684-699-6380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLMAN",
        "first_name": "SAM",
        "middle_name": "ERONI",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-05",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "AS",
            "license": "5063C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wynchrister Enriquez
• Rubie Anne Espinosa, MD
• Manuel F Fernandez, M.D.
• Saipale Fuimaono, MBBS
• Tafou Aso Fuiono, MBBS
• Ariel Siautapini Galeai, MA PSYCHOLOGY
• Mamerto D Garvez, MD
• Maria Myla Vincencio Gayapa, MD
• Robert Malcaba Gayapa, M.D.
• Apaitia Ulutegu Goneyali, MBBS,MMED

• Public Health & General Preventive Medicine Physician in Pago Pago, AS
• Providers in Pago Pago, AS by specialty
• Public Health & General Preventive Medicine Physician in American Samoa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.