MR. KEVIN S FULLER PA-C
NPI 1417119652
Physician Assistant in Fairfax, VA

Q: What is Kevin Fuller's NPI number?

The NPI number for Kevin Fuller is 1417119652. It was assigned to this individual provider in the NPPES registry on June 30, 2008.

Q: What is Kevin Fuller's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Kevin Fuller was last updated on April 21, 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.

Active since June 30, 2008PECOS Enrolled

81.28/100

CMS Quality Rating

13135 LEE JACKSON MEMORIAL HWY STE 305, FAIRFAX, VA 22033(703) 359-8640(703) 591-6105 Get Directions Write a Review

NPPES record last updated: April 21, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 21, 2021, Mar 6, 2020, Aug 21, 2019 (3 updates tracked since 2019).

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About Mr. Kevin S Fuller Pa-c NPPES

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

MR. KEVIN S FULLER PA-C (NPI 1417119652) is an individual physician assistant in Fairfax, Virginia, licensed in Virginia (0110001208) and active in the NPI registry since June 2008. He is enrolled in Medicare PECOS and maintains a secondary practice location in Fairfax.

NPPES Registry Identity

NPI1417119652

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameMR. KEVIN S FULLERCredential: PA-C

Location Address13135 LEE JACKSON MEMORIAL HWY STE 305Fairfax, VA 22033-1907

Mailing AddressPo Box 37174Baltimore, MD 21297-3174 · (571) 423-5699 · Fax (571) 423-5698

Phone(703) 359-8640

Fax(703) 591-6105

Sole ProprietorNo

Enumeration DateJune 30, 2008

Last NPPES UpdateApril 21, 20213 updates tracked since enumeration

NPPES CertifiedApril 21, 2021

✔ NPI 1417119652 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 VA · 0110001208

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.

13135 LEE JACKSON MEMORIAL HWY STE 305, Fairfax, VA 22033

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Secondary Practice Location 1

Location 13620 Joseph Siewick Dr, Suite 406Fairfax, VA 22033-1756 · Phone (703) 359-8640 · Fax (703) 259-6324

Other Identifiers 2

Medicaid1417119652VA

Other0110001208VA · License Number

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. Kevin S 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22033 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

$100.31 typical visit price

range $65.18 – $194.86

Typical copayment $25.07 (range $16.29 – $48.71)

Most-billed visit code 99203

Established Patient

$80.66 typical visit price

range $21.40 – $158.88

Typical copayment $20.16 (range $5.35 – $39.72)

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.

81.28/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

70.77

Promoting Interoperability

100

Improvement Activities

Cost

66.84

Other Providers at the Same Location NPPES 12

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

DANIELLE M EGANHOUSE P.A.- C

Physician Assistant