Jordan Fuller, DO is a medicare enrolled "Internal Medicine" physician in Treasure Island, Florida. He went to Lake Erie College Of Osteopathic Medicine, Erie and graduated in 2016 and has 8 years of diverse experience with area of expertise as Hospitalist. He is a member of the group practice Bayside Medical Group Llc and his current practice location is
61 Dolphin Dr, Treasure Island, Florida. You can reach out to his office (for appointments etc.) via phone at
(727) 853-1701.
Jordan Fuller is licensed to practice in Florida (license number OS15231) and he also participates in the medicare program. He
may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1679922678.
Physician's Profile
| Full Name | Jordan Fuller |
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| Gender | Male |
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| Speciality | Hospitalist |
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| Experience | 8 Years |
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| Location | 61 Dolphin Dr, Treasure Island, Florida |
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| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Jordan Fuller attended and graduated from Lake Erie College Of Osteopathic Medicine, Erie in 2016
NPI Data:
- NPI Number: 1679922678
- Provider Enumeration Date: 06/09/2016
- Last Update Date: 04/24/2024
Medicare PECOS Information:
- PECOS PAC ID: 9032402375
- Enrollment ID: I20190717000845
Medical Identifiers
Medical identifiers for Jordan Fuller such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1679922678 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207R00000X | Internal Medicine | OS15231 (Florida) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Bayside Medical Group Llc | 9931325990 | 6 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jordan Fuller allows following entities to bill medicare on his behalf.
| Entity Name | Bayside Medical Group Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215353818
PECOS PAC ID: 9931325990
Enrollment ID: O20140728001785 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jordan Fuller is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jordan Fuller, DO
61 Dolphin Dr,
Treasure Island, FL 33706-3113
Ph: () - | Jordan Fuller, DO
61 Dolphin Dr,
Treasure Island, FL 33706-3113
Ph: (727) 853-1701 |
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