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MR. MICHAEL JOHN FULLAM PA
NPI 1255599163
Physician Assistant in Patchogue, NY

Active since May 28, 2008PECOS EnrolledAccepts Medicare Assignment
84.47/100
CMS Quality Rating
107 N OCEAN AVE, PATCHOGUE, NY 11772(631) 654-5004 Get Directions Write a Review

NPPES record last updated: February 25, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Michael John Fullam Pa NPPES

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

MR. MICHAEL JOHN FULLAM PA (NPI 1255599163) is an individual physician assistant in Patchogue, New York, licensed in New York (006268) and active in the NPI registry since May 2008. He is enrolled in Medicare PECOS, is affiliated with Suny/stony Brook University Hospital, and is a graduate of Other (1997).

NPPES Registry Identity

NPI1255599163
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. MICHAEL JOHN FULLAMCredential: PA
Location Address107 N OCEAN AVEPatchogue, NY 11772-2012
Mailing Address25 Northumberland DrShoreham, NY 11786-2000 · (631) 846-6984
Phone(631) 654-5004
Sole ProprietorNo
Medical School CMSOtherGraduated 1997
Enumeration DateMay 28, 2008
Last NPPES UpdateFebruary 25, 2021
NPPES CertifiedFebruary 25, 2021
✔ NPI 1255599163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 006268
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
107 N OCEAN AVE, Patchogue, NY 11772
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Michael John Fullam Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2163314618
PECOS Enrollment IDI20040419001486
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.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308
A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.
91 services60 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010
A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.
81 services77 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000
An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
77 services74 patients
Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes 99305
An initial nursing facility visit per day is a service where a healthcare professional spends about 35 minutes assessing a patient's health status. This includes reviewing medical history, conducting a physical exam, and developing a care plan based on the patient's needs.
71 services70 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
66 services64 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
17 services14 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Suny/Stony Brook University Hospital

Acute Care Hospitals · Stony Brook, NY
4/5 CMS rating
OwnershipGovernment - State
CMS Certification Number330393
LocationHealth Sciences Center SunyStony Brook, NY 11794 · Suffolk County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11772 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

84.47/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality93.33
Promoting Interoperability100
Improvement Activities40
Cost54.91

Other Providers at the Same Location NPPES 3

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

MS. ALLISON P BOYLE P.A.
Physician Assistant (Medical)
107 N OCEAN AVE
PATCHOGUE, NY 11772
Suffolk County (631) 654-5004
DR. CHERESE M LAPORTA D.O.
Family Medicine
107 N OCEAN AVE, SUITE G
PATCHOGUE, NY 11772
Suffolk County (631) 654-5004
CHERESE M. LAPORTA D.O., PLLC
Family Medicine
107 N OCEAN AVE, SUITE G
PATCHOGUE, NY 11772
Suffolk County (631) 654-5004

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 Michael Fullam's NPI number?

The NPI number for Michael Fullam is 1255599163. It was assigned to this individual provider in the NPPES registry on May 28, 2008.

Where is Michael Fullam located?

Michael Fullam practices at 107 N Ocean Ave, Patchogue, NY 11772. The listed phone number is (631) 654-5004.

What is Michael Fullam's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Michael Fullam enrolled in Medicare?

Yes. Michael Fullam is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Michael Fullam affiliated with any hospitals?

According to CMS data, Michael Fullam is affiliated with Suny/Stony Brook University Hospital.

When was this NPI record last updated?

The NPPES record for Michael Fullam was last updated on February 25, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.