JUSTIN SCOTT FULLER PA
NPI 1609767227
Student in an Organized Health Care Education/Training Program in Madras, OR

NPI Status: Active since July 11, 2025

Contact Information

470 NE A ST
MADRAS, OR
ZIP 97741
Phone: (541) 475-4800
Fax: (541) 475-4805

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  • Individual
  • Male
  • Years of Experience 1
  • Student in an Organized Health Care Educ...
  • May Accept Medicare Approved Payment
  • PECOS Enrolled

About JUSTIN FULLER

This page provides the complete NPI Profile along with additional information for Justin Fuller, a primary care provider established in Madras, Oregon with a medical specialization in Student In An Organized Health Care Education/training Program and more than one year of experience. The healthcare provider is registered in the NPI registry with number 1609767227 assigned on July 2025. The practitioner's primary taxonomy code is 390200000X. The provider is registered as an individual and his NPI record was last updated April 2026.

NPI
1609767227
Provider Name
JUSTIN SCOTT FULLER PA
Gender
Male
Entity Type
Individual
Location Address
470 NE A ST MADRAS, OR 97741
Location Phone
(541) 475-4800
Location Fax
(541) 475-4805
Mailing Address
4311 11TH AVE NE STE 200 SEATTLE, WA 98105
Medical School Name
OTHER
Graduation Year
2025
Is Sole Proprietor?
No
Enumeration Date
07-11-2025
Last Update Date
04-16-2026
Code Navigator

A primary care provider (PCP) like Justin Fuller sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

Location Map

Secondary Locations

  • 4311 11th Ave NE Ste 200
    Seattle, WA 98105
    (206) 616-4001

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Student in an Organized Health Care Education/Training Program

Taxonomy Code
390200000X
Type
Student, Health Care
Taxonomy Description
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Medicare Participation & PECOS Enrollment Status

Justin Fuller is registered with Medicare but maybe doesn't accept claims assignment. If you are a Medicare beneficiary call and confirm with the provider before seeking any services.

Justin Fuller is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 3971097114

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20251215001856

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Maybe

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Justin Fuller is affiliated with the following medical facilities:

Hospital Name Address Phone Hospital Type Overall Rating
ST CHARLES MADRAS470 NE A STREET
MADRAS, OR 97741
(541) 475-3882Critical Access Hospitals

Reviews for JUSTIN SCOTT FULLER PA

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1609767227, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
6
Unchanged
Pos 3
0
Doubled → 0
Pos 4
9
Unchanged
Pos 5
7
Doubled → 14 → 1 + 4
Pos 6
6
Unchanged
Pos 7
7
Doubled → 14 → 1 + 4
Pos 8
2
Unchanged
Pos 9
2
Doubled → 4
Check
7
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 0 → 0 7 → 14 → 5 7 → 14 → 5 2 → 4

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 6 + 0 + 9 + 1 + 4 + 6 + 1 + 4 + 2 + 4 + 24 = 63

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 63 is 70. The difference is the calculated check digit.

70 - 63 = 7
This NPI is valid
The calculated check digit is 7, which matches the last digit of 1609767227.

Other Providers at the Same Location


The following 15 providers are registered at the same or a nearby location.

Emergency Medicine
470 NE A ST
MADRAS, OR 97741
Nurse Anesthetist, Certified Registered
470 NE A ST
MADRAS, OR 97741
Rehabilitation Unit
470 NE A ST
MADRAS, OR 97741
Registered Nurse (Home Health)
470 NE A ST
MADRAS, OR 97741
Pharmacist
470 NE A ST
MADRAS, OR 97741
Psychiatry & Neurology (Neurology)
470 NE A ST
MADRAS, OR 97741
Radiology (Diagnostic Radiology)
470 NE A ST
MADRAS, OR 97741
Physician Assistant
470 NE A ST
MADRAS, OR 97741
Podiatrist (Foot & Ankle Surgery)
470 NE A ST
MADRAS, OR 97741
Family Medicine
470 NE A ST
MADRAS, OR 97741
Family Medicine (Adult Medicine)
470 NE A ST
MADRAS, OR 97741
Family Medicine
470 NE A ST
MADRAS, OR 97741
Family Medicine
470 NE A ST
MADRAS, OR 97741
Nurse Practitioner (Family)
470 NE A ST
MADRAS, OR 97741
Family Medicine
470 NE A ST
MADRAS, OR 97741

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1609767227, enumerated as an "individual" on July 11, 2025.

The provider is located at 470 NE A ST MADRAS, OR 97741 and the phone number is (541) 475-4800.

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Justin Fuller is affiliated with: ST CHARLES MADRAS.