Jon D. Fuller
Family Medicine

Address: 725 Albany Street, Shapiro 9, Suite B, Boston, MA 02118-2526
Phone: 6174144290

Jon D. Fuller (NPI# 1952387946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1952387946
Entity Type Individual
Full Name Jon D. Fuller
Credential MD
Gender Male
Practice Address 725 Albany Street
Shapiro 9, Suite B
Boston
MA 02118-2526
Practice Telephone 6174144290
Practice Fax Number 6174144285
Mailing Address 720 Harrison Ave
Dob 503
Boston
MA 02118-2371
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2005-12-21
Last Update Date 2014-05-12

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 207Q00000X Family Medicine Allopathic & Osteopathic Physicians 70785 MA

Other Provider Identifier

State Identifier Issuer Type Code
MA 110044024A MEDICAID

Other Providers JON FULLER

NPI Name Taxonomy Address Enumeration
1376566976 Jon Gordon Fuller Jr. Dentist 570 W 400 N, Moab, UT 84532-2236 2006-07-25
1245270412 Jon D Fuller Internal Medicine 3801 Miranda Ave., Va Palo Alto Hcs, Palo Alto, CA 94304 2006-06-07
1225080765 Jon D Fuller Surgery 7 Shackleford West Blvd, Little Rock, AR 72211-3886 2006-05-16

Physician Overview

NPI 1952387946
PAC ID by PECOS 5193767911
Professional Enrollment ID I20050523000647
Full Name Jon D. Fuller
Organization Legal Name EVANS MEDICAL FOUNDATION INC
Gender M
Credential MD
Medical School UNIVERSITY OF CALIFORNIA, SAN DIEGO SCHOOL OF MEDICINE
Graduation Year 1983
Primary Specialty FAMILY PRACTICE
Group Practice PAC ID 7416946546
Number of Group Practice Members 364
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
220031 BOSTON MEDICAL CENTER

Office Location

Street Address 725 ALBANY STREET
SHAPIRO 9, SUITE B
City BOSTON
State MA
Zip Code 02118-2526

Providers in the same location

NPI Name Taxonomy Address Enumeration
1699772715 Theresa Clare Weir Nurse Practitioner 725 Albany Street, Shapiro 5 and 6, Boston, MA 02118-2526 2005-07-05
1033670955 Kevin Keller Student in an Organized Health Care Education/Training Program 725 Albany Street, Precepting Room, Boston, MA 02128 2019-03-26
1982164737 Maria Irene Barillas Lara Student in an Organized Health Care Education/Training Program 725 Albany Street, Shapiro Primary Care, Precepting Room, Boston, MA 02128 2019-03-20
1053870956 Antreas Charidimou Student in an Organized Health Care Education/Training Program 725 Albany Street, Shapiro Primary Care, Precepting Room, Boston, MA 02118-2526 2019-03-19
1740749969 Amir Gilad Student in an Organized Health Care Education/Training Program 725 Albany Street, Shapiro Primary Care, Precepting Room, Boston, MA 02128 2019-03-18
1194284356 Sandro Marini Student in an Organized Health Care Education/Training Program 725 Albany Street, Shapiro Primary Care, Precepting Room, Boston, MA 02116 2019-03-18
1770042988 Matthew Custodio Student in an Organized Health Care Education/Training Program 725 Albany Street, Precepting Room, Boston, MA 02128 2019-03-18
1093287047 Adela Medina Nurse Practitioner 725 Albany Street, Shapiro 7, Suite B, Boston, MA 02118 2018-12-31
1124501853 Jennifer Marie Becklehimer Nurse Practitioner 725 Albany Street, Shapiro 7, Suite B, Boston, MA 02118 2018-09-09
1063904142 Erika Thoft-brown Physician Assistant 725 Albany Street, Shapiro Lower Level, Boston, MA 02118-2526 2018-06-04
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1780145292 Fangnan Elisha Ndam Student in an Organized Health Care Education/Training Program 670 Albany Street 4th Floor, Department of Pathology and Laboratory Medicine, Boston, MA 02118 2019-03-27
1083174478 Kevin Stirling Student in an Organized Health Care Education/Training Program Shapiro Primary Care 725 Albany Street, Precepting Room, Boston, MA 02118 2019-03-21
1568922250 Katherine Wegman Student in an Organized Health Care Education/Training Program Boston Medical Center - Bcd Building, One Boston Medical Center Place, Boston, MA 02118 2019-03-20
1831659689 Anthony John Mell Student in an Organized Health Care Education/Training Program 1 Boston Medical Center Place Dept of Pediatrics, Menino Building, Dowling 3 South Resident Mailboxes, Boston, MA 02118 2019-03-20
1538628789 Pratima Agarwal Student in an Organized Health Care Education/Training Program 800 Harrison Avenue, Bcd 5th Floor, Boston, MA 02118 2019-03-18
1629537758 Tracy A Ledger Nurse Practitioner 830 Harrison Ave Moakley, 3rd Floor, Boston, MA 02118 2019-03-18
1467911701 Bijan Ghaffari Student in an Organized Health Care Education/Training Program 720 Harrison Ave # Dob505, Boston, MA 02118 2019-03-17
1467910695 Alice Ma Student in an Organized Health Care Education/Training Program Department of Radiology 820 Harrison Ave Fgh Building, 4th Floor, Boston, MA 02118 2019-03-06
1851857338 Ruth Madeline Mateo Nurse Practitioner 30 Northhampton Street, Boston, MA 02118 2019-02-20
1205311966 Jacqueline Husid Social Worker 1313washingtonst., Uniy 707, Boston, MA 02118 2018-09-28
Find all providers in zip 02118

Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1720586779 Kathleen Armstrong Family Medicine 47 Howitt Rd, Boston, MA 02132-6401 2018-01-24
1578099404 Medexpress Primary Care Massachusetts, P.C. Family Medicine 578 Huntington Ave Fl 2, Boston, MA 02115-5902 2017-05-11
1093129488 Maya Yasmin Mauch Family Medicine South End Community Health Center, 1601 Washington St., Boston, MA 02118 2014-06-13
1467701821 One Medical Group, PC Family Medicine 28 State Street, Suite 2850, Boston, MA 02109 2012-08-31
1861750333 Jessica R Gray Family Medicine 720 Harrison Ave., Dob 503, Boston, MA 02118 2012-05-02
1841589231 Steven J Zivich Family Medicine 12 Clarendon St, Boston, MA 02116 2011-04-06
1205063930 Michael P. Lowney Family Medicine 1234 Hyde Park Ave Ste 101, Boston, MA 02136-2819 2009-06-21
1730355512 Elizabeth A Schaefer Family Medicine 400 Brookline Ave Apt 14c, Boston, MA 02215-5406 2008-05-01
1952580805 Alice Birdese Brown Family Medicine 1 Longfellow Place, 2323, Boston, MA 02114 2007-10-29
1457544892 Masaya Higuchi Family Medicine 165 Cambridge St Ste 502, Boston, MA 02114 2007-08-20
Find all providers in BOSTON

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City BOSTON
Zip Code 02118

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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