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

Active since July 11, 2025PECOS Enrolled
470 NE A ST, MADRAS, OR 97741(541) 475-4800(541) 475-4805 Get Directions Write a Review

NPPES record last updated: April 16, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 16, 2026, Jul 11, 2025 (2 updates tracked since 2025).

About Justin Scott Fuller Pa NPPES

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

JUSTIN SCOTT FULLER PA (NPI 1609767227) is an individual student in an organized health care education/training program in Madras, Oregon and active in the NPI registry since July 2025. He is enrolled in Medicare PECOS, is affiliated with St Charles Madras, and maintains a secondary practice location in Seattle.

NPPES Registry Identity

NPI1609767227
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJUSTIN SCOTT FULLERCredential: PA
Location Address470 NE A STMadras, OR 97741-1844
Mailing Address4311 11th Ave Ne Ste 200Seattle, WA 98105-6367
Phone(541) 475-4800
Fax(541) 475-4805
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateJuly 11, 2025
Last NPPES UpdateApril 16, 20262 updates tracked since enumeration
NPPES CertifiedApril 16, 2026
✔ NPI 1609767227 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
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.
470 NE A ST, Madras, OR 97741
Open in Google Maps ↗

Secondary Practice Location 1

Location 14311 11th Ave NE Ste 200Seattle, WA 98105-6367 · Phone (206) 616-4001

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Justin Scott Fuller Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3971097114
PECOS Enrollment IDI20251215001856
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.

St Charles Madras

Critical Access Hospitals · Madras, OR
OwnershipVoluntary non-profit - Private
CMS Certification Number381324
Location470 NE A StreetMadras, OR 97741 · Jefferson County
Emergency services Birthing friendly

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.

CEP AMERICA - NEUROLOGY PC
Psychiatry & Neurology (Neurology)
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 475-3882
AJ SCHUSTER MD
Family Medicine
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 475-4800
MOUNTAIN VIEW HOSPITAL
Rehabilitation Unit
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 460-4063
WILLIAM P IRVINE MD
Family Medicine
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 475-4800
LAURA A SCHWEGER, PC
Podiatrist (Foot & Ankle Surgery)
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 383-3668
DR. LEONARD DEWITT SAVAGE M.D.
Family Medicine (Adult Medicine)
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 475-4800
DR. JENNIFER TRIPP PHARM D
Pharmacist
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 141-5085
DR. JINNELL ANN LEWIS M.D.
Family Medicine
470 NE A ST
MADRAS, OR 97741
Jefferson County (541) 475-4800

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 Justin Fuller's NPI number?

The NPI number for Justin Fuller is 1609767227. It was assigned to this individual provider in the NPPES registry on July 11, 2025.

Where is Justin Fuller located?

Justin Fuller practices at 470 NE A St, Madras, OR 97741. The listed phone number is (541) 475-4800.

What is Justin Fuller's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Justin Fuller enrolled in Medicare?

Yes. Justin Fuller is registered in the Medicare PECOS enrollment system.

Is Justin Fuller affiliated with any hospitals?

According to CMS data, Justin Fuller is affiliated with St Charles Madras.

When was this NPI record last updated?

The NPPES record for Justin Fuller was last updated on April 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months 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.