NPIMap

Individual provider Active NPI

Phillip Tyler Fuller, M.D.

  • Urology Physician
  • Ada, OK
National Provider Identifier
1871720300
Registry record updated Jun 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
30483 Issued in OK
Practice address
1414 Arlington Street
Suite 2300
Ada, OK 74820
Phone
(580) 332-0112
Fax
(580) 332-1005
NPI assigned
Jun 11, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 30483 OK Primary

Addresses

Primary practice location

1414 Arlington Street
Suite 2300
Ada, OK 74820

Mailing address

1414 Arlington Street
Suite 2300
Ada, OK 74820
Phone (580) 332-0112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20141201001941 TX Practitioner - Urology 9335373802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Oklahoma College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30483OKMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center CurrentSince Oct 14, 2014 Accepting new patients
Southern Oklahoma Urology, Inc CurrentSince Jul 1, 2014 Accepting new patients
Chickasaw Nation Division of Health CurrentSince Oct 14, 2014 Accepting new patients
Chickasaw Nation Division of Health Current Accepting new patients
Ross Enterprises Inc PastSince Aug 15, 2017 Accepting new patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center Past Accepting new patients

Locations

1414 Arlington St
Ste 2300
Ada, OK 74820
Phone (405) 332-0112

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Interoperability endpoints

  • Direct secure messaging: pfuller21829@direct.chickasawnationhealth.net
  • Direct secure messaging: pfuller@soku.mdlogic.direct-ci.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 6

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 6

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": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1871720300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 ARLINGTON STREET",
            "address_2": "SUITE 2300",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-332-0112",
            "fax_number": "580-332-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 ARLINGTON STREET",
            "address_2": "SUITE 2300",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-332-0112",
            "fax_number": "580-332-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "PHILLIP",
        "middle_name": "TYLER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-11",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OK",
            "license": "30483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.