NPIMap

Individual provider Active NPI

Edwin R Fuller III, MD

  • Nephrology Physician
  • Chapel Hill, NC
National Provider Identifier
1922022110
Registry record updated May 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
0501405 Issued in NC
Practice address
7024 Burnett-Womack Building
CB#7155
Chapel Hill, NC 27599-0001
Phone
(919) 966-2561
Fax
(919) 966-4251
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 0501405 NC Primary

Addresses

Primary practice location

7024 Burnett-Womack Building
CB#7155
Chapel Hill, NC 27599-0001

Mailing address

7024 Burnett-Womack Building
CB#7155
Chapel Hill, NC 27599-0001
Phone (919) 966-2561

Other practice location 1

1301 Central Dr
Sanford, NC 27330-4159
Phone (919) 718-9512

Other identifiers 1

IdentifierTypeStateIssuer
5901671MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address efuller12408@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050912000909 NC Practitioner - NephrologyPractitioner - Internal Medicine 8022041904 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Maryland School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of North Carolina at Chapel HillGroup PAC ID 0648181156, 2,028 clinicians

Practice addresses (Care Compare)

100 Eastowne Dr
Chapel Hill, NC 27514-2286
Phone (984) 215-5556

101 Manning Dr
Chapel Hill, NC 27514-4220

Hospital & facility affiliations

  • Unc Hospitals Hospital, Chapel Hill, NC, CCN 340061
  • Rex Hospital Hospital, Raleigh, NC, CCN 340114
  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028
  • Southeastern Regional Medical Center Hospital, Lumberton, NC, CCN 340050
  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0501405NCMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unc Physicians Network, LLC CurrentSince Apr 4, 2014 Accepting new patients
Unc Physicians Network LLC Current Accepting new patients
Unc Physicians Network LLC CurrentSince Apr 4, 2014 Accepting new patients
University of North Carolina at Chapel Hill CurrentSince Jul 26, 2005 Accepting new patients
University of North Carolina at Chapel Hill CurrentSince Jul 26, 2005 Accepting new patients
Park Ophthalmology Past Accepting new patients

Locations

100 Eastowne Dr
Fl 14
Chapel Hill, NC 27514
Phone (984) 215-5556

101 Manning Dr
Chapel Hill, NC 27514
Phone (984) 974-1485

940 Martin Luther King Jr Blvd
Chapel Hill, NC 27514
Phone (919) 942-5123

102 Mason Farm Rd
Chapel Hill, NC 27599
Phone (919) 966-1459

2000 Perimeter Park Dr
Ste 200
Morrisville, NC 27560
Phone (800) 594-8624

1301 Central Dr
Sanford, NC 27330
Phone (919) 718-9512

Interoperability endpoints

  • Direct secure messaging: efuller12408@direct.unc.nchie.net

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620432000000",
    "number": "1922022110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7024 BURNETT-WOMACK BUILDING",
            "address_2": "CB#7155",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275990001",
            "telephone_number": "919-966-2561",
            "fax_number": "919-966-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7024 BURNETT-WOMACK BUILDING",
            "address_2": "CB#7155",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275990001",
            "telephone_number": "919-966-2561",
            "fax_number": "919-966-4251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Central Dr",
            "address_purpose": "LOCATION",
            "city": "Sanford",
            "state": "NC",
            "postal_code": "273304159",
            "country_code": "US",
            "telephone_number": "919-718-9512",
            "fax_number": "919-718-9516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "EDWIN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-05-08",
        "certification_date": "2021-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "0501405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901671",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efuller12408@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1301 Central Dr",
            "city": "Sanford",
            "state": "NC",
            "country_code": "US",
            "postal_code": "273304159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chapel Hill, NC

Sources for this page

Verify at the official NPI Registry.