MRS. MARY FULLER DNP
NPI 1497364053
Nurse Practitioner in Kewanee, IL

Active since July 29, 2020PECOS EnrolledAccepts Medicare Assignment
110 N BURR BLVD, KEWANEE, IL 61443(309) 852-0197(309) 854-5575 Get Directions Write a Review

NPPES record last updated: August 4, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 4, 2020, Jul 30, 2020 (2 updates tracked since 2020).

About Mrs. Mary Fuller Dnp NPPES

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

MRS. MARY FULLER DNP (NPI 1497364053) is an individual nurse practitioner in Kewanee, Illinois, licensed in Illinois (209021513) and active in the NPI registry since July 2020. She is enrolled in Medicare PECOS, is affiliated with Osf Saint Luke Medical Center, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1497364053
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameMRS. MARY FULLERCredential: DNP
Location Address110 N BURR BLVDKewanee, IL 61443-2214
Mailing Address110 N Burr BlvdKewanee, IL 61443-2214 · (309) 852-0197 · Fax (309) 854-5575
Fax(309) 854-5575
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateJuly 29, 2020
Last NPPES UpdateAugust 4, 20202 updates tracked since enumeration
NPPES CertifiedAugust 4, 2020
NPI 1497364053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License Licensed in IL · 209021513
Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedPreventive Medicine · Public Health & General Preventive MedicineTaxonomy 2083P0901X · License 209021513 (IL)
Also ListedNurse Practitioner · Primary CareTaxonomy 363LP2300X · License 209021513 (IL)
110 N BURR BLVD, Kewanee, IL 61443

Other Identifiers 1

Medicaid366006568001IL

Accepted Insurance

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

Mrs. Mary Fuller Dnp 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 ID4082033642
PECOS Enrollment IDI20200930002898
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.

Hospital Affiliations CMS Care Compare

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

Osf Saint Luke Medical Center

Critical Access Hospitals · Kewanee, IL
OwnershipVoluntary non-profit - Private
CMS Certification Number141325
Location1051 West South StreetKewanee, IL 61443 · Henry County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61443 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
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
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.

Other Providers at the Same Location NPPES 15

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

Clinic/Center (Rural Health)
110 N BURR BLVD
KEWANEE, IL 61443
Nurse Practitioner (Psychiatric/Mental Health)
110 N BURR BLVD
KEWANEE, IL 61443
Nurse Practitioner
110 N BURR BLVD
KEWANEE, IL 61443
Nurse Practitioner
110 N BURR BLVD
KEWANEE, IL 61443
Clinic/Center (Adolescent and Children Mental Health)
110 N BURR BLVD
KEWANEE, IL 61443
Registered Nurse
110 N BURR BLVD
KEWANEE, IL 61443
Counselor (Mental Health)
110 N BURR BLVD
KEWANEE, IL 61443
Licensed Practical Nurse
110 N BURR BLVD
KEWANEE, IL 61443

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 Mary Fuller's NPI number?

The NPI number for Mary Fuller is 1497364053. It was assigned to this individual provider in the NPPES registry on July 29, 2020.

Where is Mary Fuller located?

Mary Fuller practices at 110 N Burr Blvd, Kewanee, IL 61443. The listed phone number is (309) 852-0197.

What is Mary Fuller's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Mary Fuller enrolled in Medicare?

Yes. Mary Fuller 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.

What insurance does Mary Fuller accept?

Health plans from Ambetter Health, Ambetter Health of Delaware and Ambetter from Home State Health list Mary 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.

Is Mary Fuller affiliated with any hospitals?

According to CMS data, Mary Fuller is affiliated with Osf Saint Luke Medical Center.

When was this NPI record last updated?

The NPPES record for Mary Fuller was last updated on August 4, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.