NPIMap

Individual provider Active NPI

Melissa J Fuller, APRN, AGCNS-BC

  • Clinical Nurse Specialist
  • Boulder, CO
National Provider Identifier
1871371146
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
APN.10000013-CNS Issued in CO
Practice address
4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone
(303) 415-7000
NPI assigned
Sep 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Continuing Education/Staff Development Registered Nurse 163WC1600X RN.0186597 CO
Clinical Nurse Specialist 364S00000X APN.10000013-CNS CO Primary

Addresses

Primary practice location

4747 Arapahoe Ave
Boulder, CO 80303-1131

Mailing address

4079 Longhorn Dr
Lafayette, CO 80026-9634
Phone (303) 524-4507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20241204002688 CO Practitioner - Nurse Practitioner 5294261079 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-7610

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.0186597COMDContinuing Education/Staff Development Registered Nurse
APN.10000013-CNSCOMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Nov 1, 2024 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health CurrentSince Nov 1, 2024 Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

4747 Arapahoe Ave
Ste 1N
Boulder, CO 80303

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

Organizations & group practices 5

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 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1871371146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4079 LONGHORN DR",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800269634",
            "telephone_number": "303-524-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 ARAPAHOE AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031131",
            "telephone_number": "303-415-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "MELISSA",
        "middle_name": "J",
        "credential": "APRN, AGCNS-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-18",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Continuing Education/Staff Development",
            "state": "CO",
            "license": "RN.0186597",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "CO",
            "license": "APN.10000013-CNS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.