JEREMY WAYNE FULLER NP-C
NPI 1285221440
Nurse Practitioner - Family in Santa Rosa, CA

Q: What is Jeremy Fuller's NPI number?

The NPI number for Jeremy Fuller is 1285221440. It was assigned to this individual provider in the NPPES registry on December 22, 2020.

Q: What is Jeremy Fuller's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Jeremy Fuller was last updated on February 24, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 22, 2020PECOS EnrolledAccepts Medicare Assignment

220 CONCOURSE BLVD, SANTA ROSA, CA 95403(844) 527-7369 Get Directions Write a Review

NPPES record last updated: February 24, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 24, 2025, Dec 22, 2020 (2 updates tracked since 2020).

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About Jeremy Wayne Fuller Np-c NPPES

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

JEREMY WAYNE FULLER NP-C (NPI 1285221440) is an individual family provider in Santa Rosa, California, licensed in California (95015009) and active in the NPI registry since December 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1285221440

Entity TypeIndividualMale

Primary Taxonomy363LF0000X

Provider Legal NameJEREMY WAYNE FULLERCredential: NP-C

Location Address220 CONCOURSE BLVDSanta Rosa, CA 95403-8210

Mailing Address220 Concourse BlvdSanta Rosa, CA 95403-8210 · (844) 527-7369

Phone(844) 527-7369

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateDecember 22, 2020

Last NPPES UpdateFebruary 24, 20252 updates tracked since enumeration

NPPES CertifiedFebruary 24, 2025

✔ NPI 1285221440 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95015009

Also ListedNurse PractitionerTaxonomy 363L00000X · License 95015009 (CA)

220 CONCOURSE BLVD, Santa Rosa, CA 95403

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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

Jeremy Wayne Fuller Np-c 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 ID8224492558

PECOS Enrollment IDI20230919003902

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95403 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

$96.16 typical visit price

range $63.04 – $187.01

Typical copayment $24.04 (range $15.76 – $46.75)

Most-billed visit code 99203

Established Patient

$109.88 typical visit price

range $21.02 – $153.40

Typical copayment $27.47 (range $5.25 – $38.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 11

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

JULIE BARLOW ACNP-BC

Nurse Practitioner (Acute Care)