Michael A Fuller, M.D.
Individual provider Active NPI Psychiatry Physician · Galveston, TX
NPI 1922054725 · NPPES record last updated Sep 13, 2012
Key facts
- NPI
- 1922054725
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- H6226 (TX)
- Practice address
- 301 University Blvd
Galveston, TX 77555-0190 - Phone
- (409) 747-9722
- Fax
- (409) 747-8367
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- University of Texas Medical Branch at Galveston, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bluebonnet Trails Community MHMR Center
Practice addresses (Care Compare)
1009 N Georgetown St
Round Rock, TX 78664-3289
Phone (512) 255-1720
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061004000256 | TX | Practitioner - Psychiatry | 8921004516 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluebonnet Trails Community MHMR Center | Current |
Accepting new patients | |
| Utmb Faculty Group Practice | Psychiatry | Current |
Accepting new patients |
| Bluebonnet Trails Community MHMR Center | Psychiatry | Current |
Accepting new patients |
| Spindletop MHMR Services | Current |
Accepting new patients | |
| Spindletop MHMR Services | Current |
Accepting new patients |
Locations
2750 S 8th St
Beaumont, TX 77701
Phone (409) 838-6203
301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883
1009 N Georgetown St
Round Rock, TX 78664
Phone (512) 244-8374
7510 FM 1765
Texas City, TX 77591
Phone (409) 935-6083
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | H6226 | TX | Yes |
Addresses
Primary practice location
301 University Blvd
Galveston, TX 77555-0190
Mailing address
2122 Avenue K
Galveston, TX 77550-4645
Phone (409) 939-9409
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 139588114 | Other | TX | CIDC TPI |
Other providers in Galveston, TX
- Mary Rebecca French
- Amanda Danielle Fridley
- Jorge Luis Fuentes
- Sharon Marie Fuentes
- Perry L Fulcher
- Joe S Funston
- Yumna Furqan
- Caroline Ashlie Gaddis
- Jaclyn Rachelle Gaffey
- Netyka Gage
All providers in Galveston, TX · Psychiatry Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.