JEREMY WAYNE FULLER (NP-C) – Family Nurse Practitioner, NPI 1285221440
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
16,360 NURSE PRACTITIONER in CA
Provider Addresses for JEREMY WAYNE FULLER (NP-C)
220 CONCOURSE BLVD
SANTA ROSA, CA 954038210
Phone: (844) 527-7369
Type: Mailing
630 OVERHILL DR
REDDING, CA 960010218
Phone: (530) 333-3821
Type: Mailing
29632 HWY. 299 EAST
ROUND MOUNTAIN, CA 96084
Phone: (530) 337-5750
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $200.
Total Amount is formed as General ($200) + Research ($0) + Ownership ($0) = $200.
Last reported payment date: 2024-11-25 • Largest payer in this snapshot: Indivior Inc. ($116).
Total Amount
$200
General + Research + Ownership
Payments
9
Total payment records
General Amount
$200
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-25
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Indivior Inc. | $116 |
| Lilly USA, LLC | $39 |
| ABBVIE INC. | $24 |
| Vanda Pharmaceuticals Inc. | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-09-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20230919003902 | I | Nurse Practitioner | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 95403)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pain Management, Anesthesiology | CA | |
| Anesthesiology, Pain Management | CA | |
| Pain Management, Anesthesiology | CA | |
| Physical Therapist In Private Practice | CA | |
| Nurse Practitioner | CA | |
| Physical Therapist In Private Practice | CA | |
| Physical Therapist In Private Practice | CA |
Reviews
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