DR. SAM FULLER MD
NPI 1649569484
Surgery - Plastic and Reconstructive Surgery in South Bend, IN

Q: What is Sam Fuller's NPI number?

The NPI number for Sam Fuller is 1649569484. It was assigned to this individual provider in the NPPES registry on April 1, 2011.

Q: What is Sam Fuller's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Q: When was this NPI record last updated?

The NPPES record for Sam Fuller was last updated on September 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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 April 01, 2011PECOS EnrolledAccepts Medicare Assignment

82.19/100

CMS Quality Rating

53880 CARMICHAEL DR, SOUTH BEND, IN 46635(574) 247-9441(574) 247-9442 Get Directions Write a Review

NPPES record last updated: September 3, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 3, 2024, Nov 15, 2023, Dec 12, 2016 (3 updates tracked since 2016).

On this page

About Dr. Sam Fuller Md NPPES

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

DR. SAM FULLER MD (NPI 1649569484) is an individual plastic and reconstructive surgery provider in South Bend, Indiana, licensed in Indiana (01075560A) and active in the NPI registry since April 2011. He is enrolled in Medicare PECOS, is affiliated with Saint Joseph Regional Medical Center, and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1649569484

Entity TypeIndividualMale

Primary Taxonomy2086S0122X

Provider Legal NameDR. SAM FULLERCredential: MD

Location Address53880 CARMICHAEL DRSouth Bend, IN 46635-1567

Mailing Address3600 W Bethel AveMuncie, IN 47304-5407

Phone(574) 247-9441

Fax(574) 247-9442

Sole ProprietorNo

Medical School CMSUniversity Of Chicago, Pritzker School Of MedicineGraduated 2009

Enumeration DateApril 1, 2011

Last NPPES UpdateSeptember 3, 20243 updates tracked since enumeration

NPPES CertifiedSeptember 3, 2024

✔ NPI 1649569484 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0122X

License✔ Licensed in IN · 01075560A

Definition

A surgeon who specializes in plastic and reconstructive surgery.

Also ListedSurgery · Surgery of the HandTaxonomy 2086S0105X · License 01075560A (IN)

53880 CARMICHAEL DR, South Bend, IN 46635

Open in Google Maps ↗

Secondary Practice Locations 3

Location 160160 Bodnar BlvdMishawaka, IN 46544-9338 · Phone (574) 247-9441

Location 2303 S Nappanee St Ste FElkhart, IN 46514-2066 · Phone (574) 247-9441

Location 32349 Lake Ave Ste 201Plymouth, IN 46563-7837 · Phone (574) 247-9441

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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

Dr. Sam Fuller Md 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 ID4880989847

PECOS Enrollment IDI20160830001218

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.

Medicare Billing Reassignment

Medicare enrollment records show Sam Fuller reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Central Indiana Orthopedics, LLC

84 mi

Orthopaedic Surgery

706 N RIVER DR
Marion, IN 46952

Reassigned Medicare billing, Indiana enrollment
135 clinicians in this Medicare group

NPI 1619694726 (765) 664-2671

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 19

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Injection, triamcinolone acetonide, not otherwise specified, 10 mg J3301

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

289 services96 patients

New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

138 services138 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

126 services113 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

88 services66 patients

Injection into tendon or ligament 20550

An injection into a tendon or ligament involves placing medication directly into these areas to help reduce inflammation and pain. It's often used for conditions like arthritis or tendonitis. The procedure is quick and usually involves a local anesthetic.

75 services54 patients

X-ray of hand, minimum of 3 views 73130

An X-ray of the hand, minimum of 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the bones in your hand from different angles. This helps in diagnosing fractures, infections, arthritis, or other abnormalities. It's quick and painless.

63 services55 patients

Aspiration and/or injection of fluid from small joint 20600

This procedure involves inserting a thin needle into a small joint to remove (aspirate) or inject fluid. It can help diagnose conditions, relieve discomfort, or administer medication directly into the joint. It's generally safe with minimal discomfort.

46 services40 patients

X-ray of wrist, minimum of 3 views 73110

An X-ray of the wrist, minimum of 3 views, is a diagnostic procedure that uses radiation to create images of your wrist from different angles. This helps detect fractures, infections, or other abnormalities for accurate diagnosis and treatment planning.

44 services28 patients

Release of wrist ligament using an endoscope 29848

This procedure involves using a small camera, called an endoscope, to view and treat a tight wrist ligament. The endoscope is inserted through a tiny incision, reducing recovery time and scarring. It helps to relieve pain and improve wrist function.

34 services28 patients

Incision of tendon covering of finger 26055

This procedure involves making a small cut into the protective sheath around a finger tendon. It's typically done to relieve pressure or inflammation, improve finger movement, or treat conditions like trigger finger. It's a safe, often outpatient procedure.

28 services20 patients

X-ray of finger, minimum of 2 views 73140

An X-ray of the finger involves capturing images of your finger from at least two different angles. This non-invasive procedure helps in visualizing the bones and joints, aiding in the diagnosis of fractures, infections, or other abnormalities. Minimal discomfort may be experienced.

25 services15 patients

Application of elbow to finger cast 29075

An elbow to finger cast is applied to immobilize the arm from the elbow down to the fingers. This aids in healing fractures or severe sprains. The cast, made from plaster or fiberglass, wraps around the arm, providing support and limiting movement to promote recovery.

18 services12 patients

Cast supplies, short arm cast, adult (11 years +), fiberglass Q4010

A short arm cast, made from fiberglass, is often used for fractures or injuries to the wrist or forearm in adults and children over 11. It's lightweight, durable, and can be molded to fit your arm comfortably. This cast allows for limited movement while ensuring proper healing.

17 services12 patients

Removal of bone joints between wrist and fingers 25447

This procedure involves the surgical removal of bone joints between your wrist and fingers. It's typically done to relieve pain or restore function due to conditions like arthritis. After removal, the space may be filled with a graft or artificial joint.

15 services15 patients

Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm 12052

This procedure involves repairing a wound on the face, ears, eyelids, nose, lips, or mouth that measures between 2.6-5.0 cm. The process includes cleaning, suturing if necessary, and dressing the wound to promote healing and prevent infection.

14 services12 patients

Aspiration and/or injection of fluid from medium joint 20605

This procedure involves a needle being inserted into a medium-sized joint, such as a knee or shoulder, to remove (aspirate) excess fluid. Sometimes, medication may also be injected into the joint to reduce inflammation and pain.

14 services12 patients

Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm 11642

This procedure involves the surgical removal of a cancerous skin growth on the face, ears, eyelids, nose, lips, or mouth. The growth is between 1.1-2.0 cm in size. This is done to prevent the cancer from spreading and to restore health.

13 services11 patients

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

13 services11 patients

Transfer of tendon to back of hand 26480

A transfer of tendon to the back of the hand is a surgical procedure aimed at improving hand function. It involves moving a healthy tendon from one area to another to replace a damaged or non-functioning one, helping to restore movement and strength.

12 services12 patients

Hospital Affiliations CMS Care Compare 5

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

Saint Joseph Regional Medical Center

Acute Care Hospitals · Mishawaka, IN

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number150012

Location5215 Holy Cross PkwyMishawaka, IN 46545 · St. Joseph County

Emergency services Birthing friendly

Elkhart General Hospital

Acute Care Hospitals · Elkhart, IN

4/5 CMS rating

OwnershipGovernment - Local

CMS Certification Number150018

Location600 E BlvdElkhart, IN 46514 · Elkhart County

Emergency services Birthing friendly

Saint Joseph Regional Medical Center - Plymouth

Acute Care Hospitals · Plymouth, IN

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number150076

Location1915 Lake AvePlymouth, IN 46563 · Marshall County

Emergency services

Community Hospital Of Bremen Inc

Critical Access Hospitals · Bremen, IN

OwnershipVoluntary non-profit - Private

CMS Certification Number151300

Location1020 High RdBremen, IN 46506 · Marshall County

Emergency services

Lakeland Hospital, St Joseph

Acute Care Hospitals · St Joseph, MI

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number230021

Location1234 Napier AvenueSt Joseph, MI 49085 · Berrien County

Emergency services Birthing friendly

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.

82.19/100

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

Individually scored

Quality

71.44

Promoting Interoperability

Improvement Activities

Reported Quality Measures

Advance Care Plan

72%453 patients3/55-star benchmark: 100%

Breast Cancer Screening

32%408 patients2/55-star benchmark: 93%

Closing the Referral Loop: Receipt of Specialist Report

83%443 patients4/55-star benchmark: 87%

Colorectal Cancer Screening

45%841 patients3/55-star benchmark: 88%

Documentation of Current Medications in the Medical Record

95%2,106 patients4/55-star benchmark: 100%

e-Prescribing

90%160 patients1/55-star benchmark: 100%

Falls: Screening for Future Fall Risk

76%441 patients4/55-star benchmark: 100%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Patients combinedPopulations: 82% · 1,257 patients

Patients screened: 87% · 1,257 patients

54%149 patients3/55-star benchmark: 100%

Provide Patients Electronic Access to Their Health Information

77%357 patients4/55-star benchmark: 100%

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

86%36 patients4/55-star benchmark: 91%

Use of High-Risk Medications in Older Adults

Lower rates are better for this measure.

Patients appropriateDiagnosis: 0% · 463 patients

Patients totalRate: 2% · 463 patients

2%463 patients4/55-star benchmark: 100%

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Platform attachment, walker, each E0154

DME-Other DME · category DE000N

1 supplier11 claims11 services$4.19 avg. paid by Medicare

Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment L3808

DME-Orthotic Devices · category DF000N

2 suppliers11 claims11 services$248.78 avg. paid by Medicare

Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf L3908

DME-Orthotic Devices · category DF000N

3 suppliers19 claims21 services$48.58 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

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

MELANIE DAGGY PTA

Physical Therapy Assistant