Individual provider Active NPI

Elizabeth J. Fuller, MSN, RN, CNS

  • Adult Health Clinical Nurse Specialist
  • Indianapolis, IN
National Provider Identifier
1962535674
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X
License
28090249A Issued in IN
Practice address
1633 N Capitol Ave
Suite 436
Indianapolis, IN 46202-1261
Phone
(317) 962-6603
Fax
(317) 962-2049
NPI assigned
Mar 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Clinical Nurse Specialist 364SA2200X 28090249A IN Primary

Addresses

Primary practice location

1633 N Capitol Ave
Suite 436
Indianapolis, IN 46202-1261

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other identifiers 1

IdentifierTypeStateIssuer
28090249AOtherINSTATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address efuller@direct.iuhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070706000543 IN Practitioner - Certified Clinical Nurse Specialist (CNS) 8325000995 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Master of Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
28090249AINMDAdult Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Care Associates, Inc CurrentSince Jan 1, 2018 Accepting new patients
Iu Health Medical Group, LLC CurrentSince Jul 1, 2025 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Locations

5208 Reliable Pkwy
Chicago, IL 60686

11725 Illinois St
Carmel, IN 46032
Phone (317) 617-4808

11725 Illinois St
Ste 245
Carmel, IN 46032
Phone (317) 249-2703

7230 Engle Rd
Ste 100
Fort Wayne, IN 46804
Phone (317) 620-0232

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

1633 N Capitol Ave
Ste 436
Indianapolis, IN 46202
Phone (317) 962-6600

8820 S Meridian St
Ste 200
Indianapolis, IN 46217
Phone (317) 865-6750

1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754

1701 N Senate Blvd
Bldg C6
Indianapolis, IN 46202
Phone (913) 962-2000

8820 S Meridian St
Indianapolis, IN 46217
Phone (317) 865-6700

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 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": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1962535674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 N CAPITOL AVE",
            "address_2": "SUITE 436",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462021261",
            "telephone_number": "317-962-6603",
            "fax_number": "317-962-2049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "ELIZABETH",
        "middle_name": "J.",
        "name_prefix": "Mrs.",
        "credential": "MSN, RN, CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "IN",
            "license": "28090249A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "28090249A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efuller@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "1633 N Capitol Ave",
            "address_2": "Suite 436",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462021261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.