DR. GREGORY W FULLER (D.O.) – Emergency Medicine Physician, NPI 1174569107
Emergency Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. GREGORY W FULLER (D.O.)
1006, Airport Road, Blackman Charter Township, Jackson County, Michigan, 49202, United States
JACKSON, MI 492021851
Phone: (517) 784-6663
Fax: (517) 787-7976
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $20.
Total Amount is formed as General ($20) + Research ($0) + Ownership ($0) = $20.
Last reported payment date: 2024-02-22 • Largest payer in this snapshot: CSL Behring ($20).
Total Amount
$20
General + Research + Ownership
Payments
1
Total payment records
General Amount
$20
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-02-22
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CSL Behring | $20 |
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: 2024-11-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20040128001055 | I | Emergency Medicine | MI | TBD |
| I20241112004506 | I | Emergency Medicine | FL | 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 49202)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine | MI | |
| - | IL | |
| - | MI | |
| - | MI | |
| - | MI | |
| - | OH | |
| - | NY | |
| - | OH | |
| - | MI | |
| - | MI |
Reviews
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