NPIMap

Individual provider Active NPI

Wayne A Fuller, MD

  • Anesthesiology Physician
  • Muskegon, MI
National Provider Identifier
1952390700
Registry record updated Feb 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
WF091854 Issued in MI
Practice address
1700 Clinton St
Muskegon, MI 49442-5502
Phone
(231) 726-3511
NPI assigned
Oct 14, 2005
Last updated
Feb 28, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X WF091854 MI Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090807000213 MI Practitioner - Anesthesiology 7012060544 Reassigns benefits to 3 organizations
I20220124002372 WI Practitioner - Anesthesiology 7012060544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Mary's Health ServicesGroup PAC ID 4981500436, 175 clinicians
Munson Healthcare Otsego Memorial HospitalGroup PAC ID 8325942535, shared by 8 NPIs, 126 clinicians

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
WF091854MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health System Corporation Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Aug 7, 2023 Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Anesthesiology CurrentSince Aug 7, 2023 Accepting new patients
Mercy Health System Corporation CurrentSince Dec 27, 2021 Accepting new patients
Mercy Health System Corporation CurrentSince Dec 27, 2021 Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Aug 7, 2023 Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Anesthesia Associates of Muskegon PLC Past Accepting new patients
Owensboro Health, Inc Past Accepting new patients
American Anesthesiology Associates of Michigan, PC Anesthesiology 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

  • Direct secure messaging: wfuller21402@direct.trinity-health.org

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 13

Hospital & facility affiliations 2

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": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330387200000",
    "number": "1952390700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W WESTERN AVE",
            "address_2": "SUITE B",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494401045",
            "telephone_number": "231-726-4498",
            "fax_number": "231-726-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 CLINTON ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425502",
            "telephone_number": "231-726-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "WAYNE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2012-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "WF091854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.