MRS. MARY FULLER DNP
NPI 1497364053
Nurse Practitioner in Kewanee, IL
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
Specialties & Licenses 3
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignment
Medicare enrollment records show Mary Fuller reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Kewanee, IL 61443
- Reassigned Medicare billing, Illinois enrollment
- 11 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, ILPhysician 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.
Other Providers at the Same Location NPPES 19
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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.
Which organization bills Medicare for Mary Fuller's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Fuller reassigns Medicare benefits to County Of Henry (Kewanee, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Fuller's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mary Fuller accept?
Health plans from Ambetter Health, Ambetter Health of Delaware and Wellmark Health Plan of Iowa, Inc. 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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Mrs. Mary Fuller, DNP · NPI 1497364053
Nurse Practitioner physician in Kewanee, Illinois. Individual provider, active in the CMS NPPES registry since July 29, 2020.
## Identity
- **NPI:** 1497364053 (Entity type: Individual)
- **Enumerated:** July 29, 2020
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **State license:** 209021513 (Illinois)
- **Sole proprietor:** No
## Practice location
- **Address:** 110 N BURR BLVD, Kewanee, IL 61443-2214
- **Phone:** (309) 852-0197 · **Fax:** (309) 854-5575
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** County Of Henry (NPI 1851394829, Kewanee, IL), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2019
## Record status
- **NPPES last updated:** August 4, 2020
- **Other identifiers:** Medicaid 366006568001 (IL)
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Source: [NPI Profile](https://npiprofile.com/npi/1497364053) · Data from the CMS NPPES public registry.