Collin Michael Fuhrman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA57864 Issued in CA

Practice address

101 E Valencia Mesa Dr
Fullerton, CA 92835-3809

Phone

(714) 626-8500

NPI assigned

Feb 18, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• St Jude Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Fullerton, CA
  • NPI 1720190804
  Medicare reassignment

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1902439938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 SUGARPINE DR",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926791409",
            "telephone_number": "949-554-9634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353809",
            "telephone_number": "714-626-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUHRMAN",
        "first_name": "COLLIN",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA57864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT BOARD",
            "identifier": "PA57864",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Frye, MSW
• Delione Marquise Frye
• Jacqueline Frye
• Darlene Fuentes
• Jennifer Anne Fuentes, N.P.
• Austin Derrik Fuller
• Earl S. Fuller, M.D.
• Gary Michael Fuller, COUNSELOR ADDICTION
• Jonathan Fuller
• La Crystal L. Fuller, RNP, RNFA

• Physician Assistant in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; 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.