Active NPI
Jason Fuller, M.S. CCC-SLP
- Speech-Language Pathologist
- Searcy, AR
National Provider Identifier
1972718401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1372
- Practice address
- 1208 W Pleasure Ave
Searcy, AR 72143-5151 - Phone
- (501) 230-3916
- NPI assigned
- May 10, 2007
- Last updated
- Jul 26, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1372 | AR | Primary |
Addresses
Primary practice location
1208 W Pleasure Ave
Searcy, AR 72143-5151
Mailing address
708 W Academy Ave
Searcy, AR 72143-4109
Phone (501) 230-3916
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5T864 | Other | AR | AR BLUECROSS BLUESHIELD |
| 135025721 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1372 | AR | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason Fuller | Speech-Language Pathologist | Past | Accepting new patients |
| Clearly Speaking LLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Speech-Language Pathologist
- Searcy, AR
- NPI 1851659825
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311638400000",
"number": "1972718401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "708 W ACADEMY AVE",
"city": "SEARCY",
"state": "AR",
"postal_code": "721434109",
"telephone_number": "501-230-3916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 W PLEASURE AVE",
"city": "SEARCY",
"state": "AR",
"postal_code": "721435151",
"telephone_number": "501-230-3916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "JASON",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2011-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "1372",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AR BLUECROSS BLUESHIELD",
"identifier": "5T864",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "135025721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Searcy, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.