KELLY ANNE FULLER
NPI 1861964553
Marriage & Family Therapist in Rialto, CA
About Kelly Anne Fuller NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY ANNE FULLER (NPI 1861964553) is an individual marriage & family therapist in Rialto, California, licensed in California (100457) and active in the NPI registry since December 2018. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly Anne Fuller is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Fuller reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Rialto, CA 92376
- Reassigned Medicare billing, California enrollment
- 233 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.
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.
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 Kelly Fuller's NPI number?
The NPI number for Kelly Fuller is 1861964553. It was assigned to this individual provider in the NPPES registry on December 19, 2018.
Where is Kelly Fuller located?
Kelly Fuller practices at 850 E Foothill Blvd, Rialto, CA 92376. The listed phone number is (909) 580-2866.
What is Kelly Fuller's specialty?
The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.
Is Kelly Fuller enrolled in Medicare?
Yes. Kelly Fuller is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Fuller's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Fuller reassigns Medicare benefits to County Of San Bernardino (Rialto, CA). 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 Kelly Fuller's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kelly Fuller was last updated on December 19, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Kelly Anne Fuller · NPI 1861964553
Marriage & Family Therapist provider in Rialto, California. Individual provider, active in the CMS NPPES registry since December 19, 2018.
## Identity
- **NPI:** 1861964553 (Entity type: Individual)
- **Enumerated:** December 19, 2018
- **Primary specialty:** Marriage & Family Therapist · taxonomy 106H00000X
- **State license:** 100457 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 850 E FOOTHILL BLVD, Rialto, CA 92376-5230
- **Phone:** (909) 580-2866
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** County Of San Bernardino (NPI 1235348533, Rialto, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 19, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1861964553) · Data from the CMS NPPES public registry.