Edward Steven Fuller, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5601002984 Issued in MI

Practice address

22101 Moross Road
Detroit, MI 48236-2172

Phone

(313) 343-6866

NPI assigned

Jan 8, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Henry Ford Health St. John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088
  NPD
• Pathology Specialists of Southeast Michigan PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Detroit, MI
  • NPI 1023100500
  NPD
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932257672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5041 YANKEE",
            "city": "ST. CLAIR",
            "state": "MI",
            "postal_code": "48079",
            "telephone_number": "810-329-6435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS ROAD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362172",
            "telephone_number": "313-343-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "EDWARD",
        "middle_name": "STEVEN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601002984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Full Spectrum CC LLC
• Full Spectrum Compassionate Care
• Jennifer Fuller Bohanon, MA, LPC
• Bridget Fuller
• Brittany S Fuller, MD
• Gwendolyn Natasha Fuller
• Isaiah Fuller -CCH Fuller, BS
• Moneth Fuller
• Vincent Fulton Sr., LBSW
• K'Ara Fultz, MEDICAL ASSISTANT

• Surgical Physician Assistant in Detroit, MI
• Providers in Detroit, MI by specialty
• Surgical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.