CMS-1500 Box 24J / 33a • NPI
1497364053
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363L00000X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner
Box 32 Service Location & ZIP+4
110 N BURR BLVD, KEWANEE, IL, 61443-2214
✓ 9-Digit EDI 837 ZIP+4 (61443-2214)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1497364053 (MARY FULLER, DNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1497364053 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | MARY FULLER, DNP |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner NUCC Code: 363L00000X (Nurse Practitioner) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 110 N BURR BLVD, KEWANEE, IL, 61443-2214 |
| Practice Telephone / Fax | Tel: (309) 852-0197 | Fax: (309) 854-5575 |
| Administrative Mailing Address | 110 N BURR BLVD, KEWANEE, IL, 61443-2214 |
| Enumeration & Last Sync | Enumerated: 2020-07-29 | CMS Record Updated: 2020-08-04 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363L00000X)
What Does Taxonomy Code 363L00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363L00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (MARY FULLER, DNP)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
2083P0901X — Preventive Medicine, Public Health & General Preventive MedicinePlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine, Public Health & General Preventive Medicine | State: IL | License: 209021513 | Primary: Secondary |
363LP2300X — Nurse Practitioner, Primary CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care | State: IL | License: 209021513 | Primary: Secondary |
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: IL | License: 209021513 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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