Shannia Fullerton

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

AA621 Issued in FL

Practice address

62 Columbia St
Orlando, FL 32806-1115

Phone

(321) 214-4903

Fax

(321) 843-2196

NPI assigned

Aug 26, 2020

Last updated

Dec 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

Enrollment records 2

Specialty

Anesthesiology Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brevard Physician Associates PLLCGroup PAC ID 1850535048, 221 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cape Canaveral Hospital Hospital, Cocoa Beach, FL, CCN 100177
• Viera Hospital Hospital, Melbourne, FL, CCN 100315
• Holmes Regional Medical Center Hospital, Melbourne, FL, CCN 100019

Merit-based Incentive Payment System (MIPS)

Final score

79.91 of 100Reported as group

Quality

61.18

Promoting interoperability

100

Improvement activities

40

Cost

71.86

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts

State licenses

Practice roles

Locations

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.

• Brevard Physician Associates, PLLC

  • Anesthesiology Physician
  • Melbourne, FL
  • NPI 1598008955
  Medicare reassignment Care Compare group NPD
• Orlando Anesthesia Consultants PA

  • Anesthesiology Physician
  • Ocoee, FL
  • NPI 1184661696
  Medicare reassignment NPD
• Orlando Health Medical Group Inc

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1669429577
  Medicare reassignment NPD
• Piedmont Anesthesia Associates, L.L.C

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1407856594
  Medicare reassignment NPD
• Piedmont Anesthesia LLC

  • Anesthesiology Physician
  • Stockbridge, GA
  • NPI 1700474244
  Medicare reassignment NPD
• Orlando Health Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Winter Park, FL
  • NPI 1265019541
  NPD
• Mohawk Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Minneola, FL
  • NPI 1689133290
  NPD (past)

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

• Cape Canaveral Hospital, Inc.

  • General Acute Care Hospital
  • Cocoa Beach, FL
  • NPI 1184691610
  Care Compare affiliation
• Holmes Regional Medical Center, Inc.

  dba First Flight

  • Air Ambulance
  • Melbourne, FL
  • NPI 1235312281

  Hospital

  Care Compare affiliation
• Holmes Regional Medical Center, Inc.

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1295702728
  Care Compare affiliation
• Viera Hospital Inc

  • General Acute Care Hospital
  • Melbourne, FL
  • NPI 1730494816
  Care Compare affiliation

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1912510124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 COLUMBIA ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061115",
            "telephone_number": "321-214-4903",
            "fax_number": "321-843-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 COLUMBIA ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061115",
            "telephone_number": "321-214-4903",
            "fax_number": "321-843-2196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1775 W Hibiscus Blvd Ste 215",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329012627",
            "country_code": "US",
            "telephone_number": "321-837-3820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLERTON",
        "first_name": "SHANNIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "FL",
            "license": "AA621",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "32697719",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Fuller
• Michael Eugene Fuller, MS
• Sabrina Misty Fuller
• Veronica Fuller
• Brenna Sullivan Fullerton, M.D.
• Fullness of Life ABA Services LLC
• Fullness of Life Kid's LLC
• Mary Fullon, RN
• Jennifer Fullwood
• Madeline Fulmer

• Anesthesiologist Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Anesthesiologist Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.