Wayne A Fuller, MD
Individual provider Active NPI Anesthesiology Physician · Muskegon, MI
NPI 1952390700 · NPPES record last updated Feb 28, 2012
Key facts
- NPI
- 1952390700
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- WF091854 (MI)
- Practice address
- 1700 Clinton St
Muskegon, MI 49442-5502 - Phone
- (231) 726-3511
- NPI assigned
- Oct 14, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 22
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Saint Mary'S Health Services
Munson Healthcare Otsego Memorial Hospital
Practice addresses (Care Compare)
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (734) 263-2400
825 N Ctr Ave
Gaylord, MI 49735-1592
Phone (989) 731-2201
Hospital & facility affiliations
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Grayling Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI, WI
- 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 |
|---|---|---|---|---|
| I20090807000213 | MI | Practitioner - Anesthesiology | 7012060544 | Reassigns benefits to 3 organizations |
| I20220124002372 | WI | Practitioner - Anesthesiology | 7012060544 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WF091854 | MI | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Munson Healthcare Otsego Memorial Hospital | Current |
Accepting new patients | |
| Munson Healthcare Otsego Memorial Hospital | Current | Accepting new patients | |
| Munson Healthcare Otsego Memorial Hospital | Current |
Accepting new patients | |
| Mercy Health System Corporation | Current |
Accepting new patients | |
| Mercy Health System Corporation | Current | Accepting new patients | |
| Mercy Health System Corporation | Current |
Accepting new patients | |
| Munson Healthcare Otsego Memorial Hospital | Current | Accepting new patients | |
| Munson Healthcare Otsego Memorial Hospital | Anesthesiology | Current |
Accepting new patients |
| Munson Healthcare Otsego Memorial Hospital | Current | Accepting new patients | |
| American Anesthesiology Associates of Michigan, PC | Anesthesiology | Past | Accepting new patients |
| Anesthesia Associates of Muskegon PLC | Past | Accepting new patients | |
| Owensboro Health, Inc | Past | Accepting new patients |
Locations
29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652
825 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100
829 N Center Ave
Ste 210
Gaylord, MI 49735
Phone (989) 731-7860
1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868
Interoperability endpoints
- wfuller21402@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | WF091854 | MI | Yes |
Addresses
Primary practice location
1700 Clinton St
Muskegon, MI 49442-5502
Mailing address
550 W Western Ave
Suite B
Muskegon, MI 49440-1045
Phone (231) 726-4498
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578703252 | Medicaid | MI | |
| MI1878017 | Other | MI | MEDICARE ID-TYPE UNSPECIFIED |
Other providers in Muskegon, MI
- Lajoy Frierson
- Peter Fries
- Kimberley Kay Frohloff
- Carol Lynn Frybarger
- Ashley Lynn Frye
- Justin Gabert
- Magdalena Gadomski
- Abigail Lynn Gagnon
- Tony Gale Butto
- Suzanne Marie Galloway
All providers in Muskegon, MI · Anesthesiology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 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.