Physician Compare National (NPI:1801817267)

HEALTHCARE PROVIDER: JOHN R FULLER MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1801817267
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395743496
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080110000119
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FULLER
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	500 VINCENT ST D
	Group Practice or individual's line 1 address
City	STEVENS POINT
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	544811842
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	520002
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST MICHAEL'S HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y