Individual provider Active NPI

Colin Wyatt Fuller, M.D.

  • Pediatric Otolaryngology Physician
  • Fort Worth, TX
National Provider Identifier
1922413343
Registry record updated Jul 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X
License
W4468 Issued in TX
Practice address
1500 Cooper St
Fort Worth, TX 76104-2710
Phone
(682) 885-6850
Fax
(682) 885-6799
NPI assigned
Jun 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Otolaryngology Physician 207YP0228X W4468 TX Primary
Pediatric Otolaryngology Physician 207YP0228X 67805 OK
Otolaryngology Physician 207Y00000X 6781 GA

Addresses

Primary practice location

1500 Cooper St
Fort Worth, TX 76104-2710

Mailing address

PO Box 733784
Dallas, TX 75373-3784
Phone (682) 885-6483

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cfuller258384@CookChildrens.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210825001481 OK Practitioner - Otolaryngology 2466878491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ou Health Partners IncGroup PAC ID 5991105876, 1,167 clinicians

Practice addresses (Care Compare)

825 NE 10TH St
Oklahoma City, OK 73104-5417
Phone (405) 271-4700

900 NE 10TH St
Ouhp Family Medicine
Oklahoma City, OK 73104-5420
Phone (572) 244-0065

Hospital & facility affiliations

  • O U Medical Center Hospital, Oklahoma City, OK, CCN 370093

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6781GAMDOtolaryngology Physician
67805OKMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Aug 6, 2021 Accepting new patients
Ou Health Partners, Inc CurrentSince Aug 6, 2021 Accepting new patients
Ou Medicine Inc. Past Accepting new patients

Locations

1200 Childrens Ave
Oklahoma City, OK 73104
Phone (405) 271-2429

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

1122 NE 13th St
#274
Oklahoma City, OK 73117

Interoperability endpoints

  • Direct secure messaging: cfuller22257@ouhealth.direct-ci.net

Organizations & group practices 3

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 1

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": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785196800000",
    "number": "1922413343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-6483",
            "fax_number": "682-303-7132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 COOPER ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042710",
            "telephone_number": "682-885-6850",
            "fax_number": "682-885-6799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "COLIN",
        "middle_name": "WYATT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2026-07-28",
        "certification_date": "2026-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "TX",
            "license": "W4468",
            "primary": true
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "OK",
            "license": "67805",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "6781",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cfuller258384@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "1500 Cooper St",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761042710",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.