MRS. MAUREEN PENDERGAST FULLER (P.A.) – Physician Assistant, NPI 1558306209
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,093 PHYSICIAN ASSISTANT in MA
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Provider Addresses for MRS. MAUREEN PENDERGAST FULLER (P.A.)
Belfort Road, Pineland Gardens, Jacksonville, Duval County, Florida, 32216, United States
JACKSONVILLE, FL 322566018
Phone: (904) 446-3686
Fax: (904) 446-3032
Type: Mailing
Baystate Mary Lane Outpatient Center, 85, South Street, Ware, Massachusetts, 01082, United States
WARE, MA 010821625
Phone: (413) 967-2268
Fax: (413) 967-2548
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $90.
Total Amount is formed as General ($90) + Research ($0) + Ownership ($0) = $90.
Last reported payment date: 2024-11-21 • Largest payer in this snapshot: Smith+Nephew, Inc. ($24).
Total Amount
$90
General + Research + Ownership
Payments
4
Total payment records
General Amount
$90
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-21
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Smith+Nephew, Inc. | $24 |
| Integra LifeSciences Corporation | $24 |
| MIMEDX Group, Inc. | $23 |
| Paratek Pharmaceuticals, Inc. | $18 |
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: 2008-06-12
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 |
|---|---|---|---|---|
| I20080612000536 | I | Physician Assistant | MA | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 11042 | Removal of skin and tissue, 20.0 sq cm or less | 564 | 143 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 232 | 116 | $0 |
| 11045 | Removal of skin and tissue, each additional 20.0 sq cm or less | 222 | 32 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 148 | 88 | $0 |
| 15275 | Application of skin substitute graft to wound of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 25.0 sq cm or less of wound 100.0 sq cm or less | 78 | 19 | $0 |
Insurance plans in this area (ZIP 32256)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MA | |
| Nurse Practitioner | MA | |
| Nurse Practitioner | CT | |
| Hospitalist, Internal Medicine | MA | |
| Internal Medicine | MA |
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