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MR. FREDERICK P FULLER PA-C
NPI 1154364099
Physician Assistant - Medical in Salt Lake City, UT

Active since June 14, 2006PECOS Enrolled
50 N MEDICAL DR, SALT LAKE CITY, UT 84132(801) 581-2292 Get Directions Write a Review

NPPES record last updated: January 13, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 10, 2021, Dec 7, 2018 (2 updates tracked since 2018).

About Mr. Frederick P Fuller Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. FREDERICK P FULLER PA-C (NPI 1154364099) is an individual medical provider in Salt Lake City, Utah, licensed in Utah (9860440-1206) and active in the NPI registry since June 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154364099
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMR. FREDERICK P FULLERCredential: PA-C
Location Address50 N MEDICAL DRSalt Lake City, UT 84132-3004
Mailing AddressPo Box 413033Salt Lake City, UT 84141-3033
Phone(801) 581-2292
Sole ProprietorNo
Enumeration DateJune 14, 2006
Last NPPES UpdateJanuary 13, 20252 updates tracked since enumeration
NPPES CertifiedJanuary 13, 2025
✔ NPI 1154364099 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in UT · 9860440-1206
Also ListedPhysician AssistantTaxonomy 363A00000X · License 018646 (NY)
50 N MEDICAL DR, Salt Lake City, UT 84132
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, PacificSource Health Plans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Frederick P Fuller Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

UNIVERSITY OF UTAH ADULT SERVICES
Otolaryngology
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (801) 587-6336
ADAM PORTER MOTR/L
Occupational Therapist
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (801) 585-2119
DR. ERICA JANE ALEXANDRA COLVIN MD
Emergency Medicine
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-2121
MEGAN MEIER MD
Internal Medicine (Rheumatology)
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-2121
STACI LEE GUNTER PA-C
Physician Assistant (Surgical)
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-6908
MATTHEW D. O'DELL MD
Internal Medicine
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-7899
WATARU HORIGUCHI
Student in an Organized Health Care Education/Training Program
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (801) 581-2121
JEANELLE WEBB
Registered Nurse
50 N MEDICAL DR
SALT LAKE CITY, UT 84132
Salt Lake County (925) 510-0868

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Frederick Fuller's NPI number?

The NPI number for Frederick Fuller is 1154364099. It was assigned to this individual provider in the NPPES registry on June 14, 2006.

Where is Frederick Fuller located?

Frederick Fuller practices at 50 N Medical Dr, Salt Lake City, UT 84132. The listed phone number is (801) 581-2292.

What is Frederick Fuller's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Frederick Fuller enrolled in Medicare?

Yes. Frederick Fuller is registered in the Medicare PECOS enrollment system.

What insurance does Frederick Fuller accept?

Health plans from Molina Healthcare and PacificSource Health Plans list Frederick Fuller as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Frederick Fuller was last updated on January 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.